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My question concerns a pediatric acute care setting and CPT codes 99468, 99471, and 99475, Initial in-patient neonatal critical care. When a patient transfers from the neonatal ICU (NICU) or children’s ICU (CICU) to a regular medical floor but returns seven days later for a complication, new problem, or worsening problem, can the provider receiving the patient in the NICU or the CICU charge an initial critical care again?
Julie-Leah J. Harding, CPC, RMC, PCA, CCP, SCP-ED
Children's Hospital Boston
Yes, the provider would be able to bill an initial visit because it is based on when the child became critical, per the American Medical Association (AMA):
Codes 99471-99476 are used to report services provided by a physician directing the inpatient care of a critically ill infant or young child from 29 days of postnatal age through 5 years of age. They represent care starting with the date of admission (99471, 99475) and subsequent day(s) (99472, 99476) the infant or child remains critical. These codes may be reported only by a single physician and only once per day, per patient in a given setting. Service for the critically ill or critically injured child older than 5 years of age would be reported with critical care codes (99291, 99292).
See page 1 of the AMA’s Corrections Document—CPT 2009, available at www.ama-assn.org/ama1/pub/upload/mm/362/2009cptcorrections.pdf, for reference.
— Deborah Robb, BSHA, CPC, is physician services director for TrustHCS.