# Codes 99468 and 99469



## rrhernandez (Mar 11, 2015)

I'm hoping somebody can help with this since I've talked it out with others already and we're differing on our interpretation of the guidelines for these codes. It's also been difficult to find information on this subject. 
My situation is as follows:  I code for our Neurology physicians' visits to the NICU. Most of the time the baby will be admitted to the NICU, let's say on Tuesday, because of extreme premature birth, etc. In this case the physician will bill a 99468 Critical Care E/M code. On Wednesday the NICU team may notice that the baby is "jittery" and request a Neurologist to evaluate the patient for possible seizures. My question is: Does our Neurologist use the 99468 code (all criteria has been met for critical care and this has not been deemed to be a "Consult") since this is their first time seeing the patient, or do they use the 99469 subsequent code? Or something else?
The confusion is in the CPT guidelines and how they're being intrepreted. If you have any experience with this same type of scenario I could really use your help. Thanks!


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## Cynthia Hughes (Mar 24, 2015)

Is your physician the attending? Codes 99468 and 99469 are billed by only the physician who is supervising the overall critical care service as opposed to providing consultative services. CPT states in the prefatory language for these codes, "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." This assumes as you noted that all criteria including that the services rendered meet the definition of critical care (see prefatory language to 99291) are met.


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