EM Coding Alert

The ‘by land, air, or water’ place of service code is necessary for a complete claim.

Previously, the descriptor of the CPT® codes 99466-+99467 (Critical care face-to-face services, during an inter-facility transport of critically ill or critically injured pediatric patient, 24 months of age or younger…) left room for misinterpretation that the reportable services had to be face-to-face with the patient, not other healthcare professionals. But that has changed. 

Continue reading to familiarize yourself with the 2014 updates to the guidelines that make it easier for you to know when you can — and can’t — report the pediatric critical care transport services codes.

Start with Knowing the Background

Pediatric critical care transport services are time-based E/M services that describe face-to-face services your physician provides for critically ill or injured patients 24-months of age or younger during inter-facility transport. 

You report 99466 (Critical care face-to-face services, during an inter-facility transport of critically ill or critically injured pediatric patient, 24 months of age or younger; first 30-74 minutes of hands-on care during transport) for services that occur within the first 30 to 74 minutes of face-to-face care. Use code +99467 (Critical care face-to-face services, during an inter-facility transport of critically ill or critically injured pediatric patient, 24 months of age or younger; each additional 30 minutes [List separately in addition to code for primary service] ) with each additional 30 minutes of physician face-to-face care.

Watch out: “… to bill for the service, the provider must ride in the ambulance with the patient,” explains Kevin Solinsky, CPC, CPC-I, CEDC, CEMC, president of Healthcare Coding Consultants, LLC in Gilbert, Ariz. Most paramedics and flight nurses will only take medical direction from a medical director in this situation, adds Solinsky. 

Know the Changes to the Guideline Language

The 2014 CPT® guidelines clarified the time period you claim as critical care and instructed that time must be face-to-face time spent entirely with the patient. Time spent away from the patient conferring with other healthcare professionals for reviewing patient records is not billable. That face-to-face time begins when your physician takes responsibility of the patient at the original facility and ends when the receiving facility accepts responsibility for the care of the patient. 

The physician providing critical care during pediatric patient transport may not separately report the following:

• Routine monitoring evaluations 
• Interpretation of cardiac output measurements 
• Chest X-rays 
• Pulse oximetry 
• Blood gases and information data stored in computers 
• Gastric intubation 
• Temporary transcutaneous pacing 
• Ventilator management 
• Vascular access procedures.

If your physician performs other services not on this list, you can report them separately in addition to 99466 and +99467. 

Example: Physician A assumes care of a critically ill, severely burned, 19-month-old patient at 6 p.m., and accompanies the child to a referring facility with a dedicated burn center. The ride takes 45 minutes, during which Physician A remains at the patient’s side providing critical, face-to-face care.

Physician B, at the referring facility, assumes care of the child immediately upon the child’s arrival. Physician A spends an additional 45 minutes communicating with Physician B and additional staff at the referring facility regarding the patient’s condition.

In this case, you can count only the time between Physician A’s acceptance of primary care and his release of the patient to Physician B (45 minutes) toward the inter-facility transport time. So for Physician A you will report 99466. You can’t count the additional 45 minutes toward inter-facility transport time because they were not face-to-face and occurred after the patient’s transfer of care.

Key: Make sure you assign the right location code for 99466 and 99467. You should use place of service (POS) code 41 (Ambulance - land) for land ambulance services and POS 42 (Ambulance - air or water) for air or water emergency transports.