ED Coding and Reimbursement Alert

Changes in pediatric codes are small incidentals for the emergency department, but they're making enough impact to demand your attention. Changes in Pediatric Critical Care Pediatric critical care has two new codes:
99293 Initial pediatric critical care, 31 days up through 24 months of age, per day, for the evaluation and management of a critically ill infant or young child
99294 Subsequent pediatric critical care, 31 days up through 24 months of age, per day, for the evaluation and management of a critically ill infant or young child. Before the changes, you reported 99291 and 99292 for any infant more than one month old when critical care services were provided. That time frame has been pushed back: Report 99291 and 99292 for patients 24 months of age or older, says Michael Granovsky, MD, CPC, CFO, of Greater Washington Emergency in suburban Maryland.

Starting Jan. 1, 2003, critical care provided to a child younger than 24 months of age will no longer be paid by the hour but by the day. We will have to wait until the 2003 fee schedule is released to determine what impact this will have on payment, Granovsky says. Changes in Neonatal codes Neonatal care code 99297 was deleted.
Neonatal care code 99298 was moved out of neonatal intensive care codes and into the added low-birth-weight services subsection.
Report neonatal critical care (provided to patients 30 days or less) with one of two codes, 99295 or 99296.
Report neonatal care codes for as long as the patient qualifies for critical care through the 30th postnatal day. Note that, before the changes, you could report these codes "during the hospital stay," Granovsky says. Changes in Pediatric Transport Codes Two transport codes were revised to reflect care for pediatric patients only:

99289 Critical care services delivered by a physician, face-to-face, during an interfacility transport of critically ill or critically injured pediatric patient, 24 months of age or less; first 30-74 minutes of hands-on care during transport
+99290 ... each additional 30 minutes (list separately in addition to code for primary service). The patient transport revisions for 99289 and 99290:
limit their application to pediatric transports; do not report these codes for non-pediatric patients
tailor them to fit critical care requirements
provide clear beginning, ending times for service
require face-to-face time by the physician, not just physician's "attention"
bundle services that are bundled into critical care.