EM Coding Alert

Question: We have a low-level nursery and we get called to the hospital for standby births. Sometimes we transport a preemie to another hospital via helicopter. Our doctors do not leave the hospital. A team from the nearby hospital comes to us. Do I use the transport codes — 99466 and 99467 — for these services?

Minnesota Subscriber

Answer: No. You should not use 99466 (Critical care face-to-face services, during an interfacility 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) or +99467 (… ; each additional 30 minutes [List separately in addition to code for primary service]).

You would use 99466/+99467 only if the physician went on the transport. According to the 2017 CPT^® manual, “Only the time the physician spends in direct face-to-face contact with the patient during the transport should be reported.” This face-to-face time begins at the referring facility when the physician takes responsibility of the patient’s care, and it ends when the receiving facility takes over the patient’s care, says CPT^®.

If the physician remains in communication with the transport team, you could consider 99485 (Supervision by a control physician of interfacility transport care of the critical ill or critically injured pediatric patient, 24 months of age or younger, includes two-way communication with transport team before transport, at the referring facility and during the transport, including data interpretation and report; first 30 minutes) and +99486 (… each additional 30 minutes [List separately in addition to code for primary procedure])  — if you have the appropriate documentation from the physician.

If you admitted the baby to your facility, one option for you may be 99468 (Initial inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or younger).

If the physician was present for the infant’s birth, then 99464 (Attendance at delivery [when requested by the delivering physician or other qualified health care professional] and initial stabilization of newborn) or 99465 (Delivery/birthing room resuscitation, provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output) may be appropriate.

Note: If you use 99465, remember to separately code any procedures the physician had to perform that were a necessary part of the resuscitation such as an endotracheal intubation (31500, Intubation, endotracheal, emergency procedure).