General Surgery Coding Alert

Revisions to critical care codes in CPT 2003 mean that general surgeons can more accurately report such services for both adult and younger patients, and possibly receive greater reimbursement for neonatal critical care.

CPT 2003 more precisely differentiates critical care services provided to patients of different ages, and it changes the neonatal critical care codes to match the adult critical care codes more closely both in the definition of critical illness and in the services bundled into the codes, says Marcella Bucknam, CPC, CCS-P, CPC-H,CCA, HIM Program Coordinator at Clarkson College in Omaha, Neb.

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) and 99294 (Subsequent pediatric critical care ...) describe critical care for patients 31 days to 2 years of age.

Previously established codes 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and +99292 ( each additional 30 minutes [list separately in addition to code for primary service]) continue to describe critical care for patients older than 24 months. The same definition of "critical care" ("A critical illness or injury acutely impairs one or more vital organ systems such that there is a high probability of imminent or life-threatening deterioration in the patient's condition") applies regardless of patient age. According to AMA's CPT Changes 2003: An Insider's View, 99293/99294 reflect "the additional work related to the age of these young patients due to small size, previous therapy and limited mechanisms of physiological compensation."

CPT 2003 revises neonatal intensive care codes 99295/99296 to reflect the availability of 99293/99294, and now specify initial/subsequent neonatal critical care for the evaluation and management of a critically ill neonate, "30 days of age or less." Note that these are "per-day" codes, and CPT reserves them for neonates who require cardiac and/or respiratory support. These codes include immediate preoperative evaluation and stabilization of neonates with life-threatening surgical or cardiac conditions.

According to the revised guidelines, 99295/99296 "may be reported only once per day, per patient. Once the neonate is no longer considered to be critically ill, the Intensive Low Birth Weight Services codes for those with present body weight of less than 2500 grams (99298, 99299) or the codes for Subsequent Hospital Care (99231-99233) for those with present body weight over 2500 grams should be utilized."

CPT adds two pediatric critical care patient transport codes: 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) and +99290 (... each additional 30 minutes [list separately in addition to code for primary service]). The codes describe direct physician care during transport from one facility to another. Note that 99290 is an add-on code and must accompany 99289, and that both codes are reported according to time.