Wiki NICU billing for baby greater than 5000 grams

[dovejsd]

A newborn in our NICU needs intensive care (not critical care) but weighs more than 5000 grams. The physician marked 99480 on the encounter form, but this baby weighs more than that. There is a note in this section that states, "For the subsequent care of the sick neonate less than 28 days of age but more than 5000 grams who does not require intensive or critical care services, use codes 99231 - 99233." But this baby does require intensive services. What code do I use?

 

[FTessaBartels]

CPT restricts code

CPT restricts the code use to infants < 5001 grams. So, your choices are:
1) child requiring critical care 99472
2) child not requiring critical care 99231-99233
3) unlisted E/M 99499 (I'd price based on 99480)

It sounds as if your best option may be # 3) above, depending on documentation (of course).

F Tessa Bartels, CPC, CEMC