Pediatric Coding Alert

Question: What services are included in the new neonatal initial hospital intensive care code, 99477?North Carolina SubscriberAnswer: Many of the same services that CPT includes in neonatal and pediatric critical care (99293-99296) are also included in 99477. The same bundles also apply to initial and subsequent intensive care codes (99298-99300, 99477).Numerous services are inherent in 99477. When using 99477, you cannot separately bill these items:• umbilical venous (36510) and umbilical arterial catheters (36660)• other arterial catheters (36140, 36620)• central (36555) or peripheral vessel catheterization (36000)• vascular access procedures (36400, 36405, 36406)• vascular punctures (36420, 36600)• oral or nasogastric tube placement (43752)• endotracheal intubation (31500)• lumbar puncture (62270)• suprapubic bladder aspiration (51100)• bladder catheterization (51701, 51702)• ventilatory management (94002-94004)• CPAP (94660)• Surfactant administration (94610)• transfusion of blood components (36430, 36440)• invasive or noninvasive electronic monitoring of vital signs, bedside pulmonary function testing (94375)• monitoring or interpretation of blood gases or oxygen saturation (94760-94762).The above list includes two changes from 2007 critical care bundles:1. Aspiration code updated: The suprapubic bladder aspiration inclusion reflects CPT renumbering this procedure as 51100 instead of 51000.2. Hydration codes added: In addition, the bundles now include 90760-90761. CPT 2008 does not allow the physician in a facility (hospital setting) to report 90760-90761.Expect more: Private payers that adopt Correct Coding Initiative (CCI) edits may subject 99477 to additional bundles. CCI version 14.0, effective Jan. 1, bundles new neonatal initial hospital care code 99477 into a whopping 418 codes, says Frank Cohen, CMPA, CPA, of Health Partners in Clearwater, Fla. If you report 99477 with individual psychotherapy codes 90804-90828, therapy evaluation/re-evaluation codes 97001-97004, or scores of anesthesia or radiology codes, CCI-adherent payers will deny 99477. And 141 other codes (including almost all of the E/M codes) bundle into 99477 and are therefore not separately payable if you report them with neonatal initial hospital care.