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Thread: 99477 vs 99468

  1. #1
    Join Date
    Apr 2007

    Default 99477 vs 99468

    AAPC: Back to School
    Could someone tell me the difference between Intensive care vs Critical Care? Our Pediatrician was with a new born for about 7hrs and was considered in Critical Condition, then the baby was sent out to another hospital. We do not have a NICU. He wants to use 99477 but I see it says Intensive Care. Also can he charge a discharge for the same day too?

    Thanks in advance,

  2. #2


    Chapter 23: Initial and Continuing Intensive Care: Infant (99477-99480)

    Initial and continuing intensive care codes 99477-99480 describe services the physician provides to infants who require intensive observation, frequent interventions and other intensive services. Subsequent intensive care codes are restricted to infants 5,000 grams or less (approximately 11 pounds).

    Documentation Needs to Support Services
    Documentation must show that the neonate needs intensive care services, including (but not limited to) the following:

    •intensive cardiac and respiratory monitory
    •continuous and/or frequent vital sign monitoring
    •heat maintenance
    •enteral and/or parenteral nutritional adjustments
    •laboratory and oxygen monitoring, and
    •constant observation by the health care team under direct physician supervision.
    As long as the patient meets the above requirements and weighs 5,000 grams or less, you can apply the intensive care codes. The patient need not have previously been in critical condition to qualify for continuing intensive care.

    The neonatologist doesnt have to be in constant attendance to report 99477-99480. Instead, he must provide direct supervision of the healthcare team that provides constant observation of the recovering infant.

    Translation:The attending physician must provide direct patient contact and be readily available. The doctor doesnt have to do the procedures or provide 24-hour in-house coverage, but he needs to be physically present at some time during that 24-hour period to examine the patient and review the patients care and plan with the healthcare team.

  3. #3
    Join Date
    Apr 2007
    Milwaukee WI

    Default CPT Guidelines

    Please read the Guidelines carefully. 2010 CPT Professional Edition pg 36, 1st column, second to last paragraph, last sentence: If inpatient critical care services are reported in the referring facility prior to transfer to the receiving hospital, use the critical care code (99291, 99292). . (emphasis added by FTB)

    You should be using 99291 and 99292 to cover the critical care provided by your physician at your facility.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  4. #4
    Join Date
    Apr 2007

    Question 99477

    If one of our pediatricians is contacted by the hospital nursing staff regarding a newborn who is considered to need intensive care, and monitoring of a condition, is it appropriate for our physician to provide direction of care for the newborn from the office to the nursing staff over the phone and still bill 99477 as long as he examins the newborn within 24 hours of life?

    What if by the time the physician makes it to the hospital the newborn has stabilized and no longer requires intensive monitoring, do we still report 99477 even though the physician was not present during the "intensive care," but still examines the baby within the first 24 hours of life?

  5. #5
    Join Date
    Apr 2007
    Milwaukee WI

    Default Face to Face

    The physician MUST be present and examine the newborn before coding ANY service. If he doesn't get to the hospital until after the baby is stable, then he will not be using intensive care or NICU codes, because he did not provide any service while child required those services.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  6. #6
    Join Date
    Apr 2007
    New Windsor


    INCLUDES: Initial and subsequent services for non-critically ill infants and neonates that continue to require any of the following:

    - Adjustments to enteral and/or parenteral nutrition

    - Constant and/or frequent montoring of vitals signs

    - Continuous observation by the healthcare team

    - Heat maintenance

    - Intensive cardiac or respiratory monitoring

    - Monitoring of laboratory and oxygen values

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