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Thread: Critical Newborn, Transfer of Care

  1. #1

    Question Critical Newborn, Transfer of Care

    AAPC: Back to School
    I am hoping someone can give me a little help on this one. Family Physician delivers 39 week newborn, uncomplicated delivery, Apgars 8 and 8, at 1953.

    During the night, infant exhibits desaturations into the 80's, but otherwise appears normal. By morning, the infant has been placed on O2, is tachypneic, with good muscle tone and color. DX: acute chf, with eventual dx being hypoplastic left heart. Baby transported to another facility with neonatal ICU at 1245 when infant is approx. 17 hours old.

    My physician wants to bill for Initial newborn care (99431) and IP Neonatal Critical Care (99295).

    I think that if we bill 99295, that is the only code we should bill. I am also afraid of billing the same services as the physician the infant was transferred to. I was wondering about billing 99477, which seems more appropriate.

    If someone could give me some insight on their ideas, I would greatly appreciate it. Thanks!

  2. #2

    Smile Critical Care and Intensive Neonate

    From Medicare Sept. 08


    Here is the word for word definition from the "Coding for Pediatrics 2008" 13the Edition by the American Academy of Pediatrics:

    99477 is intended to report the more intensive services that an ill but not critically ill neonate requires on the day of admission (eg., continual monitoring, frequent adjustments of thereapy, constant observation by the health care team under direct physician supervision). These services are typically provided in a neonatal intensive care or special care unit and require a higher intensity and complexity of care than would be reported with code 99223.
    Hope this information helps. I would send it back to the provider, with the CPT definition of the 99477 and have "HIM" make the decision on whether or not this patient received the 99477 services.

  3. #3
    Join Date
    Apr 2007
    Milwaukee WI

    Default Two different dates of service?

    First - I'm at home so don't have my CPT handy...

    But from your scenario it sounds as if your physician saw baby on date of birth (99431) and then the next day when baby had so seriously deteriorated.

    99295 IS a 24-hour code and is intended to cover a wide range of services for the critically ill neonate. It could be billed on the second hospital day, but I'm not sure that both your physician and the neonatologist at the Neonatal ICU could also bill this same code on the same date.

    Can you post sanitized versions of the two progress notes? (Or admit note and discharge/transfer note?) I'll try to answer from work tomorrow ...
    You can email me privately if you like ...
    Or call me at my office tomorrow (Wed Sep 3) 10a-3p central time zone:

    F Tessa Bartels, CPC, CPC-E/M
    Reimbursement Manager
    Pediatric General Surgery

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