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Coding hospital services for sick newborn

  1. #1
    Question Coding hospital services for sick newborn
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    Family practice saw a newborn baby in the hospital - what modifiers do i use to get the following services paid?

    99232 for second day? (baby was born day before and coded a 99222 for that date) then babys health got worse so is there something different for getting a really ill baby ready for transport to another facility.
    He also did 31500 insertion of emergency airway and 32422 thoracentesis w/tube insertion. After these services baby was transported by life flight to a childrens hospital.

    What codes are acceptable for critical care of a newborn for Family Practice?


  2. #2
    Default Critical care for newborn
    Did you check the Neonatal Critical Care codes like 99295 range

  3. #3
    Milwaukee WI
    Default You should be using pediatric E/M codes
    For day one ... you would more appropriately use 99460 for the initial visit on day of life 1.

    As for day 2 ...
    Read the guidelines for Pediatric Critical Care Patient Transport (page 33 of the 2009 CPT professional edition) ... I quote in part: If inpatient critical care services are reported in the referring facility prior to transfer to the receiving hospital, use the critical care codes (99291, 99292) . This is a time-based code (must be 30 minutes or more EXCLUSSIVE of procedures). Documentation should state that the child was critically ill, the nature of that illness/condition, the critical nature of the care provided and the amount of face-to-face time spent providing critical care. ("Face-to-face" includes unit/floor time for an inpatient.) I'd recommend that at the end of the progress note documentation your physician state something along the lines of: I spent 35 minutes providing direct face-to-face critical care to this patient, exclussive of procedures.

    If your physician accompanied the patient on the flight-for-life transport, then use the Pediatric Critical Care Patient Transport codes 99466-99467 (time based).

    Be sure to add -25 modifier to the critical care code because the physician also performed procedures. DOUBLE CHECK the guidelines for critical care (pg 18-19 of the 2009 CPT professional edition) to be sure that the procedures are not bundled into 99291-92.

    Hope this helps.

    F Tessa Bartels, CPC, CEMC

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