Wiki Newborn NAS on mophine...considered critical care?

[angeslow]

Good morning-

If a newborn (28 days) is being treated in the nicu for NAS (neonatal withdrawal syndrome) with morphine, and no other issues...should it still be coded as critical care? And if so, is there anywhere to find any confirmation (CMS website?) that it should be coded as such? Or, would it just be an intensive weight based code?

-Thanks all

 

[Cynthia Hughes]

NAS and critical care

Being cared for in the NICU with morphine is not sufficient to support critical care without additional information. The patient must meet the definition of critically ill or injured and the care must include high complexity MDM to assess, manipulate, and support vital organ system functions to treat organ system failure. The patient status and type of care rendered will determine if critical, intensive, or subsequent hospital care is appropriate. Sometimes, it is a fine line but intensive care is reported for infants and neonates who are not critically ill but continue to require intensive cardiac and respiratory monitoring, continuous and/or frequent vital sign monitoring, heat maintenance, enteral and/or parenteral nutritional adjustments, laboratory and oxygen monitoring, and constant observation by the health care team under direct supervision of the physician or other qualified health care professional.

Its a clinical determination that often requires input from a physician but I hope this helps.
Cindy

Good morning-

If a newborn (28 days) is being treated in the nicu for NAS (neonatal withdrawal syndrome) with morphine, and no other issues...should it still be coded as critical care? And if so, is there anywhere to find any confirmation (CMS website?) that it should be coded as such? Or, would it just be an intensive weight based code?

-Thanks all

 

[Pathos]

Agree with the previous poster; in order to bill for critical care you need to qualify for a number of components.

AAPC released an article a few years ago that would answer most of your questions.

One side note is that Critical Care is not determined by location, meaning just because the patient is in ICU or the ER does not automatically qualify for Critical Care services. It's all about the patient's condition and the treatment the patient is getting.

Let us know if you have additional questions.

 

[grepay]

This is very close to a question I have, if the newborn is in the nursery being treated for NAS with morphine, are the intensive care codes (99477, 99478-99480) appropriate or would it be 99233?