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Thread: In Patient Step Down Unit

  1. #1
    Join Date
    Apr 2007

    Default In Patient Step Down Unit

    AAPC: Back to School
    I work for a Pediatric Hospitalist group and we are researching a step down unit. What code would I use and what documentation is required for such a unit? When a newborn is sick but not sick enough for the NICU is when the Step Down Unit would be utilized. If a newborn needs roughly 6 hours of observation/treatment in the Step Down Unit - is there a code for that? 99477 is for initial hospital care PER DAY for the evaluation and management of the neonate, 28 days of age or younger, who requires intensive observation, frequent interventions, and other intensive care services. An example of a 6 hour stay in the step down unit would be if the newborn was transient or has neonatal hypoglycemia. Would I use 99477 for a pt that needs 24 - 48 hours for R/O sepsis or maternal chorioam and neonatal maternal drug exposure?

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default 99477

    You can use the 99477 only once per day. Period. The examples you give sound like instances where this might be the appropriate code to use .. the key is the need for intensive observation and frequent intervention.

    You mention "transient" .. if you mean that the baby is in this unit while awaiting transport to another facility, then No, you wouldn't use 99477. You'd code 99291-99292 as appropriate depending on documented time spent in providing critical care.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Join Date
    Apr 2007


    Thanks so much for your help! One more question.....are the documtation requirements still the same as usual? I know that sounds a little out of the norm but the description doesn't specify specifics. Also if a newborn only stays in the step down unit for 6 hours and then goes to well baby nursery would I just code for a subsequent visit well baby for the next day?

    M Ricca, CPC

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