- A 25 weeks born preterm infant of birth weight 1400gms with RDS is admitted to neonatal ICU immediately after birth. Neonatologist performed intubation & give surfactant. Code the EM service.
Code the E/M service of neonatologist. (99468)
(a) 99468
(b) 99295
(c) 99477
(d) 99291
Rationale: Code 99468 is the correct code for initial inpatient neonatal critical care, per day, for the evaluation & management of a critically ill neonate, 28 days of age or less. Critical care management includes application of advanced technology equipments to stabilize deteriorating cardiovascular or respiratory functions (including ventilator or CPAP) if required, continuous monitoring & interpretation of vital signs, blood gasses & other biochemical parameters, frequent physician follow-up & constant observation by a health care team under direct supervision of a specialty physician. Code 99295 is deleted from CPT 2009. Code 99291 is for critical care but not for neonates. Code 99477 is the code for intensive care services but not for critical ill neonates.
Note:
- Remember that the expression “a high probably imminent or life threatening deterioration of the patient’s condition” should be part of the physician’s note to justify the condition of the patient as critical & require critical care level service.
- Intubation service & surfactant administration is bundled in the EM service, so not to be coded separately.
- The same infant was extubated after 24 hours & placed on NCPAP. He was kept on IV fluids & trophic feeding to prevent from necrotizing enterocolitis. Code the EM service.
(99469)
(a) 99477
(b) 99468
(c) 99469
(d) 99471
Rationale: Code 99469 is the correct code for this service. It is the code for subsequent inpatient neonatal critical care, per day, for the evaluation & management of a critically ill neonate, 28 days of age or less. This service can’t be coded from continuing intensive care services codes. Because the infant is still on NCPAP, which can be considered for critical care codes if documentation supports the critical nature of the illness. Code 99471 is not the code for the baby of this age. Code 99477 can’t be used because the patient is still considered for critical care. Code 99468 is for the first day of neonatal critical care.
- The same baby on 3rd day of life is now kept in oxygen hood & continued on IV fluids & gradual increments in feeding are done. Weight of new born on 3rd day is measured to be 1410gms.
(99478)
(a) 99468
(b) 99477
(c) 99478
(d) 99479
Rationale: 99478 is the correct code for this service. Codes 99478 – 99480 are the codes used to report subsequent day services provided by a physician directing the continuing intensive care of the low birth weight/normal birth weight neonates or infants who doesn’t need critical care but require intensive observations & frequent interventions (code 99478 for weight <1500gms, code 99479 for weight 1500-2500gms & code 99480 for normal birth weight babies of 2501-5000gms). Code 99477 is not used here since it is for initial intensive care, but the patient was already in critical care since two days before only subsequent intensive care codes are applied. Code 99468 is not applied for this case since the baby’s condition is now out of critical care requirements & the code 99479 is also wrong because this infant is still of <1500gms body weight.
- 33 week gestation preterm newborn baby of weight 1870gms delivered through spontaneous vaginal delivery admitted to NICU for hypotonic appearance upon initial examination. It was treated with antibiotics to manage sepsis & IV fluids. Code the EM service. (99477)
(a) 99477
(b) 99468
(c) 99223
(d) 99295
Rationale: Code 99477 is the correct code for this service since the condition of child & the treatment provided doesn’t document critical care need so it is appropriate to code this from initial & continuing intensive care services. It is for initial hospital care, per day, for the evaluation & management of the neonate, 28 days of age or less, who requires intensive care observation, frequent interventions & other intensive care services. Code 99468 is not correct as it is for critical care. Code 99295 is deleted. Code 99223 is for adult patients not for pediatric.
Note:
- Infants or neonates who can be considered for coding from intensive care services are infants of any present body weight who are not critically ill but continue to require intensive cardiac and respiratory monitoring, 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.
- Same baby monitored in the hospital remained on antibiotics through fourth day developed jaundice & the serum bilirubin was determined to be 15mg/dl. Code the EM service from day 2 to day 4. (99479X3)
(a) 99478
(b) 99479
(c) 99477
(d) 99479X3
Rationale: Code 99479X3 is the correct code for subsequent intensive care / day, for the evaluation & management of the recovering low birth weight infant (present birth weight of 1500 – 2500gms). Since the services are rendered for 3 subsequent days (2nd, 3rd & 4th) so the code 99479 is multiplied by 3. Code 99478 is inappropriate since it is for infants of below 1500gms. Code 99477 is used only for the first day of intensive care. This baby satisfies the criteria for intensive care services codes since medical record doesn’t document a critical care service.
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