Pediatric Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: A 20-month-old male patient with asthma and pneumonia (493.11 ) received treatment in our intensive care unit (ICU) for one week. The patient was transferred to the floor, but the next day his condition deteriorated, and he returned to the ICU critically ill. The patient's primary-care physician (PCP) is consulting with a pulmonary specialist about treatment. How should I code this? Maryland Reader  

Answer: If the PCPis managing this patient, he or she should code using critical care codes because the patient has organ-system failure and meets CPT's criteria for critical care. At age 20 months, these codes are 99293 (Initial pediatric critical care, 31 days up through 24 months of age, per day, for the evaluation and management of a critically ill infant or young child) for the first day, and 99294 (Subsequent pediatric critical care, 31 days up through 24 months of age, per day, for the evaluation and management of a critically ill infant or young child) for the subsequent day.

When the patient is no longer critically ill, the PCPshould use subsequent hospital care codes (99231-99233) even though the patient came from the intensive care unit.

The return of organ-system failure and the intensity of care required when the patient returns to ICU would justify reporting the initial critical care code (99293) again. Be aware that some payers may question the use of two initial critical care codes for a single hospitalization. Payers may require additional documentation if you report initial critical care twice.