Pediatric Coding Alert

Answer: There are several ways that this can be billed, but a great deal depends on how sick the child was and what the records document. If this was a critically ill child who required considerable treatment and follow-up the first day, then you should code 99295 (initial neonatal intensive care, per day, for the evaluation and management of a critically ill neonate or infant). If the child was mildly ill, then CPT 99222 (initial hospital care, per day) is appropriate.

If the child remained in an intensive care setting receiving critical care, with intensive physician follow-up, then 99296 (subsequent neonatal intensive care, per day, for the evaluation and management of a critically ill and unstable neonate or infant) or 99297 (subsequent neonatal intensive care, per day, for the evaluation and management of a critically ill though stable neonate or infant) would be the billing for the subsequent three days.

The following 17 days should not be billed as 99433 (subsequent hospital care, for the evaluation and management of a normal newborn, per day), as this was not a normal newborn, not just one who was critically ill. The subsequent days should be billed as 99298 (subsequent neonatal intensive care, per day, for the evaluation and management of the recovering very low birth weight infant [less than 1,500 grams]) if the child was under 1,500 grams, or 99231 (subsequent hospital care, per day) for a larger child. If billing the neonatal critical care codes, be sure that the chart documentation supports the critical care.

Note: The neonatal intensive care codes require the physician to be in attendance for a full day. If the pediatrician is community-based, then 99440 and 99222 or 99223 would be used for the hospital admission.