# Proc code 99468



## Mgingras (Jan 19, 2018)

Hi All!

So I'm a medical claims auditor and I have a question regarding proc code 99468. Per encoder pro this code states: Inpatient neonatal and pediatric critical care services are reported for neonates (28 days of age or younger) and pediatric patients (29 days through less than 6 years of age) beginning with the date of admission to the critical care unit and for all following days that the patient remains in the unit. Codes are only reportable once daily, per patient, by a single provider within the admission range of the specific facility. Several services are included in the care of these patients and are not separately reportable by the provider, such as monitoring vital signs, any required vascular access, ventilation oversight, blood gas, pulse oximetry measurement, evaluation of car seat, blood transfusion, oral/nasogastric tube insertion, suprapubic bladder aspiration and/or bladder catheter placement, and lumbar puncture.

My scenario is this: Code is billed twice for same DOS; different svc providers to both claims and one billed with the SA modifier; both MD's billed and were paid the exact same; DX's slightly different: 769 to one claim and 77089 to other claim; one MD is a pediatrician and other is a NICU specialist.

My question is, can this per diem code be billed twice on the same DOS? Or should only one of those provider's be billing for it? I appreciate anyone's help with this!! Thanks! 

Maria


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## thomas7331 (Jan 19, 2018)

This code should only be billed by one provider and once per date of service - additional providers should bill critical care with 99291-99292.  You can find this in the CPT book instructions under this code section:  _"These codes may be reported only by a single individual and only once per day, per patient, per hospital stay in a given facility."_  And later in the same section:  _"Critical care services provided by a second individual of a different specialty not reporting a per-day neonatal or pediatric critical care code can be reported with 99291, 99292."_


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