Wiki 99471 vs 99472 when pt ages from 28 to 29 days

[dillerisev]

I cannot find this answer anywhere. The neonate has received critical care throughout 28 days of life, the subsequents billed as 99469. But when the pt is 29 days old and receives CC, do I bill a 99471 or a 99472 for the infant/pediatric code set? I don't know if it's considered an initial or subsequent encounter.

Thanks so much!

 

[CBLENNIE]

According to the E&M Section Guidelines it states the following for Inpatient Neonatal and Pediatric Critical Care codes 99468-99476:

Codes 99468 & 99471, they represent care starting with the date of admission for critical care services. So, the way I interpret this is that you can only one of these codes which would be based on the patient’s age on the date of the hospital admission. Since the patient was under 29 days of age on admission and you likely billed 99468, as long as the admission was continuous and the patient moved into the next age range of 29 days to 24 months, you would bill 99472 for subsequent inpatient critical care services provided to the patient.

It isn't like the provider had to re-do all of the work that goes into an initial inpatient critical care visit when the patient turned 29 days old, so why would they be reimbursed for that level of service just because they moved into the next age bracket for these codes?