Wiki NI vs Well Baby Nursey

[Phlemelle]

Hello everyone,
My Dr. is billing for hospital in-stay visits on a newborn, 36 weeker with IUGR and Jaundice, who was having problems with feeding due to poor sucking reflex. Per the hospital / Nurse's notes, there is no indication that the child was in NI. The child was in the Well Baby Nursey the entire stay, 13 days, but my Dr. wants the services to be billed as NICU services because although the child was not on any monitors, he should be considered as NI. Any opinions on this scenerio.

Thanks Faye

 

[FTessaBartels]

Intensive monitoring required

I'm assuming your doctor wants to bill the 99477 to 99480 codes for the "not critically ill" neonate who continues to require intensive care services.

CPT 2009 professional edition, page 35 is pretty clear in the guidelines as to the requirements for using these codes. I quote (in part): ... These services are for infants and neonates who are not critcally ill but continue to require intensive cardiac and respistory monitoring, continuous and/or frequent vital sign monitoring, heat maintenance, enteral and/or parenteral nutritional adjustment, laboratory and oxygen monitoring, and constant observation by the health care team under direct physician supervision. . These codes are used ONCE PER DAY to reflect the physician's supervision of a round-the-clock team of healthcare professionals monitoring such an infant.

You state that per nursing notes the baby was in the well nursery the entire stay and was no no monitors at all. From that description, it does not sound as if the baby's care met the guidelines for 99477 to 99480 codes.

Hope that helps.

F Tessa Bartels, CMC, CEMC