Hi All!
So I'm a medical claims auditor and I have a question regarding proc code 99468. Per encoder pro this code states: Inpatient neonatal and pediatric critical care services are reported for neonates (28 days of age or younger) and pediatric patients (29 days through less than 6 years of age) beginning with the date of admission to the critical care unit and for all following days that the patient remains in the unit. Codes are only reportable once daily, per patient, by a single provider within the admission range of the specific facility. Several services are included in the care of these patients and are not separately reportable by the provider, such as monitoring vital signs, any required vascular access, ventilation oversight, blood gas, pulse oximetry measurement, evaluation of car seat, blood transfusion, oral/nasogastric tube insertion, suprapubic bladder aspiration and/or bladder catheter placement, and lumbar puncture.
My scenario is this: Code is billed twice for same DOS; different svc providers to both claims and one billed with the SA modifier; both MD's billed and were paid the exact same; DX's slightly different: 769 to one claim and 77089 to other claim; one MD is a pediatrician and other is a NICU specialist.
My question is, can this per diem code be billed twice on the same DOS? Or should only one of those provider's be billing for it? I appreciate anyone's help with this!! Thanks!
Maria
So I'm a medical claims auditor and I have a question regarding proc code 99468. Per encoder pro this code states: Inpatient neonatal and pediatric critical care services are reported for neonates (28 days of age or younger) and pediatric patients (29 days through less than 6 years of age) beginning with the date of admission to the critical care unit and for all following days that the patient remains in the unit. Codes are only reportable once daily, per patient, by a single provider within the admission range of the specific facility. Several services are included in the care of these patients and are not separately reportable by the provider, such as monitoring vital signs, any required vascular access, ventilation oversight, blood gas, pulse oximetry measurement, evaluation of car seat, blood transfusion, oral/nasogastric tube insertion, suprapubic bladder aspiration and/or bladder catheter placement, and lumbar puncture.
My scenario is this: Code is billed twice for same DOS; different svc providers to both claims and one billed with the SA modifier; both MD's billed and were paid the exact same; DX's slightly different: 769 to one claim and 77089 to other claim; one MD is a pediatrician and other is a NICU specialist.
My question is, can this per diem code be billed twice on the same DOS? Or should only one of those provider's be billing for it? I appreciate anyone's help with this!! Thanks!
Maria
Last edited: