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Thread: Pediatric critical care

  1. #1
    Join Date
    Apr 2007

    Default Pediatric critical care

    AAPC: Back to School
    Hi All!

    I have been told that time must be documented when billing critical care services. Does this include Pediatric Critical Care codes 99466 and 99467? Since these are new codes, I am not familiar with them and could not find it in the CPT guidlines. I have a provider that did document on his "hospital card" that the visit was a 2hr visit, but on the actual report he did not document his time. Is it necessary to have him ammend his notes to add time spent, or is time not necessary?
    Any feed back would be greatly appreciated!!!

    Thank you!
    Teresa A. Carrasco, CPC:

  2. #2

    Default pediatric critical care

    99466 Critical care services delivered by a physician, face-to-face, during an interfacility transport of critically ill or critically injured pediatric patient, 24 months of age or less; first 30-74 minutes of hands-on care during transport

    "Do not report for services less than 30 minutes duration (see evaluation and management codes)"

    I think the above exclusion is conclusive and your physician should amend his documentation and note the time spent on his report if he wants credit for this code or Evaluation and Management codes should be used.

  3. #3
    Join Date
    Apr 2007
    Milwaukee WI

    Default During transport

    To answer your question directly, YES, the physician would need to amend the documentation to reflect the time spent delivering CRITICAL CARE face-to-face, during transport.

    BUT ... Please note that the codes you reference (99466 and 99467) are to be used only for services delivered by the physician, face-to-face, during an interfacility transport

    If your physician treated the child in your hospital these are the wrong codes to use.

    Read through all the guidelines for Pediatric Critical Care to determine the if the services your physician provided are more appropriately coded with those codes (99468 through 99480 depending on the age and condition of patient, and whether it's initial or subsequent day of care).

    Critical care provided to children ages 6 and older are coded using 99291 and 99292 (depending on time).

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  4. #4
    Join Date
    Apr 2007


    Thank you so much for your reply!

    I guess that is where I am getting confused. I did code 99291 but it got denied due to the age of the patient. So I reviewed the notes again and it is for a pediatric pt who actually was seen in the ER and then had to be transported to another facility within the state. So I am leaning towards the 99468?? First thing I will do though is request that the provider ammend the notes so that time is documented!!
    Teresa A. Carrasco, CPC:

  5. #5
    Join Date
    Apr 2007
    Milwaukee WI

    Default POS 23 Emergency room

    If the patient was seen in the ER you SHOULD use 99291 (and 99292 if it was more than 30 minutes) with POS 23.

    You can use the transport codes ONLY if your physician was physically traveling with the child during transport, providing critical care.

    Read the guidelines in 2009 CPT Professional edition, page 33 under the transport section. 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)."

    Same edition, page 34 under the Inpatient Neonatal and Pediatric Critical Care codes ... To report critical care services provided in the outpatient setting (e.g. emergency department) for neonates and pediatric patients of any age, see the Critical Care codes 99291, 99292.

    Not having seen all the notes, I'm not sure but I think your situation falls under the second scenario.

    Yes, definitely have doctor amend note to include time. You mentioned 2 hours ... if that's the case you'd code 99291 x 1 AND 99292 x 2 (see table on pg 19 of 2009 CPT professional edition)

    I'd appeal, with a copy of the relevant CPT pages.

    F Tessa Bartels, CPC, CEMC

  6. #6


    There is an article in this month's Coding Edge about pediatric critical care codes if you're interested.

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