Wiki Nicu coding

[swlane@triad.rr.com]

can 99464 (attendance at delivery) and 99468 (critical admit) be coded in one day for Medicaid? CPT says yes but I have a denial for this - MEDICAID NC. Does anyone know where to find this information? Thank you so much!!!!!

 

[Tami_F]

can 99464 (attendance at delivery) and 99468 (critical admit) be coded in one day for Medicaid? CPT says yes but I have a denial for this - MEDICAID NC. Does anyone know where to find this information? Thank you so much!!!!!

Is it possible that this was denied in error?

I looked everywhere I could think of and was not able to find anything from CMS or NC Medicaid that explicitly stated whether or not it would allow these two codes to be billed on the same date of service. All I've been able to find is from CPT, which clearly states that "99464 may be reported in conjunction with 99460, 99468, 99477" (page 42, 2017 AMA CPT Professional). In the information provided in the Inpatient Neonatal and Pediatric Critical Care section on page 44 of the same book, it states, "the initial inpatient neonatal critical care code (99468) can be used in addition to 99464 or 99465 as appropriate, when the physician or other qualified health care professional is present for the delivery (99464) or resuscitation (99465) is required."

That seems awfully clear. If your physician was present for the delivery and also provided critical care for the patient, it also seems like it would be under billing if only one of those two CPT codes was used.