Pediatric Coding Alert

Your days of flipping through unrelated pages are over.

You'll have an easier time putting 99477 in its intended hierarchy thanks to CPT 2009's streamlined system.

When CPT 2008 introduced initial intensive hospital care, the only place to stick the code was in the other evaluation and management services section. This placement led to confusion regarding how to properly use 99477 (Initial hospital care, per day, for the evaluation and management of the neonate, 28 days of age or less, who requires intensive observation, frequent interventions, and other intensive care services).

The code will now start off the 2009 renumbered and relocated intensive care subsection. You can now easily see that a newborn progresses from intensive care to subsequent critical care.

Tactic: To create the proper order, "we presented a complete renumbering of all the normal newborn, delivery room, transport codes, intensive care, and neonatal and pediatric critically ill patients to CPT" in October 2007, explains Richard A. Molteni, MD, FAAP, an AMA CPT advisory committee member and a neonatalogist at Children's Hospital & Regional Medical Center in Seattle. This passed and all codes for 2009 are renumbered with room for new codes.

These fundamentals will ensure you don't get lost in the renumbered and relocated sections.

1. Look for Newborn Care in 99460s

CPT 2009 renumbers the whole newborn care section including normal newborn care. Starting Jan. 1, 2009, you will report 99431-99440 with new codes 99460-99465.

Example: You currently report normal newborn care using 99431. Your new normal newborn care code will become 99460 (Initial hospital or birthing center care, per day, for the E/M of the normal newborn infant).

2. Find Your Transport Codes Next

Pay attention if you code for a hospital that sends pediatric patients to a facility with a higher-level nursery -- or for a practice that has to coordinate an emergency transport. You'll find the pediatric critical care patient transport codes after 99465 in CPT 2009.

You currently report critical care transport using 99289 and 99290. CPT 2009 deletes these codes and replaces them with 99466 (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 to 74 minutes of hands-on care during transport) and 99467 (... each additional 30 minutes [List separately in addition to code for primary service]).

3. Rejoice Over 'Older' Child Critical Care

If the jump from daily pediatric critical care to hourly adult critical care after 24 months of age seemed extreme, you'll be pleased with the addition of two new pediatric critical care per day codes for children age 2 through 5. These codes will follow the inpatient pediatric and neonatal codes, which CPT 2009 moves to 99468-99472 from 99293-99296.
The new "older" child critical care codes include these new codes:

• 99475 -- Initial inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 2 through 5 years of age
• 99476 -- Subsequent inpatient pediatric critical care, per day, for the evaluation and management of a criti-cally ill infant or young child, 2 through 5 years of age.

"These codes build on the success of the daily bundled neonatal and current pediatric critical and intensive care codes," says Richard H. Tuck, MD, FAAP, a pediatrician at PrimeCare of Southeastern Ohio in Zanesville. Codes 99475-99476 include intensive observation, frequent interventions, extensive procedures (defined by specific CPT codes), and other intensive care services for a full calendar day. These pediatric intensive care codes have higher relative values that reflect all the work these services include, and offer an opportunity for increased payment.

4. Realize SIC Resides After 99477

A newborn who requires initial intensive care and monitoring on day 1 (99477) could progress to subsequent intensive care (SIC). Choose the correct continuing code based on the newborn's daily weight. In 2009, 99298-99300 become 99478-99480.

Example: A neonatalogist admits a newborn with fever of unknown origin who needs occasional oxygen, thermoregulation, continuous vital sign monitoring, parenteral therapy, and frequent assessments by the health care team under direct physician supervision to the intensive care unit (ICU) on Jan. 1, 2009. On day 2, the newborn, who weighs 2,800 grams, still requires intensive observation and frequent observations. You would report 99477 with date of service Jan. 1 and 99480 (Subsequent intensive care, per day, for the E/M of the recovering infant [present body weight of 2,501��"5,000 g]) for DOS Jan. 2.