Wiki 99295 vs 99296


Bolingbrook, IL
Best answers
pt admitted to nicu (99295), went to surgery, and then 'admitted' into picu after surgery and then sent back to nicu (seen by picu and nicu on same day)

1. should 99296 be used for the 'admit' into picu or should the 99295 be used?

2. for the day the pt is in picu and then sent back to nicu should only 1 dept bill the 99296 for that day?

Let's see if I have this straight...
Day 1 - patient admitted to NICU - 99295
Day 2 - patient to surgery and then post surgery to PICU, and after a period of time back to NICU - 99296 by whichever doctor gets their dictation done first. ... LOL

Seriously, this does happen with some frequency in a busy children's hospital.
We use the rule of thumb that the service that has the child for the most time bills the global Neonatal Critical Care code. This requires coordination and cooperation between the neonatologist and the pediatric intensivist, as well as their coders (if it's not the same person).

I'd code 99296 on day 2 and use as the provider whichever physician had the most critical care time with the patient. These are really sick babies, I know, but the "rules" of the code only allow it to be used once per day.

F Tessa Bartels, CPC, CPC-E/M
Thanks--that's what I thought and have been doing--but you know when someone questions you sometimes you start to second-guess yourself.