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MRA Thought of the Day – When to Charge an Initial Neonatal Critical Care CPT?

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Julie-Leah J. Harding CPC, RMC, PCA, CCP, SCP-ED, CDIS Director of Education

Julie-Leah J. Harding CPC, RMC, PCA, CCP, SCP-ED, CDIS Director of Education

Scenario:

The scenario is centered around a pediatric acute care setting and CPT codes 99468, 99471, 99475 – Initial In-Patient Neonatal Critical Care. When a patient transfers off of NICU or CICU to a regular medical floor but returns 7 days later for a complication, new problem or worsening problem, can the provider receiving the patient in the NICU or CICU charge an initial critical care again?

Here are my thoughts…

Yes they would be able to bill an initial visit because it is based on when the child became critical per the 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).

Reference: http://www.ama-assn.org/ama1/pub/upload/mm/362/2009cptcorrections.pdf

What are your thoughts?

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