Pediatric Critical Care

missmeeka85

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Hi there,

I am trying to figure out if 99468 Initial inpatient neonatal critical care is appropriate to bill for my provider, assuming all requirements are met for a critically ill infant in the NICU. What is throwing us off is that the provider was told that since he is a pediatrician that is not a hospitalist and comes in and out of the hospital, that he can't bill 99468. Is this true? He works at his own practice and will visit hospitals on the weekend.

Thank you so much!

Erin
 

jsalzer50

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Pediatric Critical Care codes

Hey Erin:

I'm a college student, and unfortunately cannot provide a definite answer. Although, I do hope this note I found provides some help:

In the 2016 CPT code book, I'm reading: "The pediatric and neonatal critical care codes include those procedures listed for the critical care codes (99291, 99292). In addition, the following procedures are also included (and are not separately reported by professionals, but may be reported by facilities) in the pediatric and neonatal critical care service codes (99468-99472, 99475, 99476) and the intensive care service codes (99477-99480)." (page 44, CPT 2016 Professional Edition)

When I read this, it sounds like the pediatric critical care codes are reported by the facility vs. the provider/physician.

- Jake
 

missmeeka85

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Hi Jake,

Thanks for this! However, I think what you're quoting refers the procedures listed below that paragraph as not separately reported by the physician. The first paragraph in the Inpatient Neonatal and Pediatric Critical Care section specifically says that an individual can report the codes. I am still learning too, so I could be wrong :)

Back to my original question, whether or not a physician that is not a hospitalist (in my case meaning they aren't at the hospital 100% of the time) can report 99468, I really think they can. I haven't found information that suggests otherwise. If anyone has something that does suggest otherwise, would love it if you could share!

Thanks!

Erin
 
Last edited:

LOUISE SLACK

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Peiatric Critical Care

Just to be clear your pediatrician is only seeing a critically ill patient in the hospital on the weekends? It seems to me like the critically ill patient must be attended to by an intensive care pediatrician or hospitalist when your provider is not present.

This is a per day code so you need to ask your provider how long do they spend managing the critically ill neonate? You could run into concurrent care issues if there is a PICU/NICU attending or hospitalist also billing for the day. I would use hourly critical care codes if your provider is not the primary physician caring for the patient and how could they be if they only see them on the weekend. And remember just because the patient is in a NICU or PICU doesn't mean that your provider is making the high level decisions required to bill critical care.

Louise
 

missmeeka85

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Estacada, OR
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Hi Louise,

Thank you for your reply! Yes, my doctor goes to the hospitals on the weekends and will go around looking at babies in the PICU and NICU. During the week, they run their own practice. I really appreciate your response and will definitely bring up the potential issue of concurrent care.

Again, thanks!

Erin
 
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