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Neonatology coding

  1. #1
    Default Neonatology coding
    Medical Coding Books
    Can somebody help me out with this. Actually the baby was delivered in our facility for the DOS 01/14/2012. The baby was moved to Neonatal intensive care unit due to respiratory problems & the resuscitation has been performed. Then due to Gastroschisis the baby has been transferred to surgical centre. In this case the since the patient has been admitted & discharged on same day can i code it as 99234-99236 series. And also for the resuscitation should 99465 should also be coded along with this.

  2. #2
    Milwaukee WI
    Default Hard to tell
    It's hard to tell without seeing all the documentation, but I think this is what you are describing.

    Baby is born at your facility, and due to critical illness is transfered to NICU. Baby also requires resuscitation. On same DOS baby is transferred to a different facility which is equipped to perform surgery.

    Key question here is for whom are you coding? Physician or facility?

    All MY expertise is with physician coding, so that is what I am answering...

    Next question is whether the same doctor provided all these services? - "admission" "resuscitation" "transfer/discharge"

    I am going to assume your answer is Yes ...
    I am ALSO going to assume that the physician(s) at the institution where you transferred the baby are in a different practice than your physician ...

    Read your CPT guidelines on the Neonatal Critical Care codes. This is from the 2012 CPT Professional Edition, published by AMA - pg 40, beginning on the bottom of the left-hand column ...
    When critical care services are provided to neonates.... at two separate institutions by a physician from a different group on the same date of service, the physician from the referring institution should report their critical care services with the critical care codes (99291, 99292) ...

    So, assuming at least 30 minutes of critical care time has been documented, you would code 99291 (plus 99292 if 75 minutes or more), 99465, and the appropriate discharge code (if you can separate that out from critical care)

    If the physician did NOT document at least 30 minutes of critical care time, then you would code the admit/discharge on same date of service plus the resuscitation.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Ur assumption is correct I am in the physician coding & same doctor provided all the services. Thanks, it was really helpful.

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