Wiki Critical Care

[clbarry8033]

If a doctor provided critical care services to a newborn for only 45 minutes, and then the newborn is deemed a normal newborn again, should a 99291 or a 99468 be billed? Also, would it be incorrect to also bill for normal newborn services in addition to the above?

Thank you!

 

[Tami_F]

My gut-reaction to this scenario is the thought that if the patient requires critical care, the patient is not a normal newborn. Pediatric critical care codes apply to all critical care provided within a 24 hour period (source).

Pediatric critical care codes are age-based:
99468-9 - 0-28 days (neonates)
99471-2 - 29 days-24 months (infants/young children)
99475-6 - 2-5 years (young children)

CPT codes 99291-2 - are time-based codes, used for patients that are six years of age and older.

There's a lot of information to wade through regarding these E/M codes in the CPT book. I'd start with page 44 in the 2017 CPT book.

Hope that helps!

 

[clbarry8033]

Thank you for the response. Just wondering if you knew if there were any other scenarios that CPT 99291 might be billed by a neonatal intensivist besides when transferring a critically ill neonate to another hospital?