Pediatric Coding Alert

CPT 2008 fills the 99295-to-9922x gap

Tired of undervaluing your initial assessment of a sick newborn with low-paying hospital codes? Relief is in sight with new code 99477 coming in CPT 2008.
 
Get the inside scoop on next year’s easier--hopefully higher-paying--solution to coding for initial inpatient care of a noncritically ill neonate. Plus, find out when to apply the new code with three scenarios.

Welcome Code for Sick, Noncritically Ill Neonate

CPT 2008 fills a hole in your newborn coding. “There hasn’t been much between critical care and initial hospital care,” says Betsy Nicoletti, MS, CPC, author of The Field Guide to Physician Coding, and owner of Medical Practice Consulting based in Springfield, Vt.

Example: A newborn is not in respiratory failure but is in respiratory distress. Although the newborn is sick, she does not require critical care.

Now you have critical care, which requires direct supervision of one physician for 24 hours and carries an incredibly high relative value (almost 25 RVUs for 99295 or about $947)--or you have initial hospital care with few RVUs (4.96 RVUs for 99223, which pays about $188 using the 2007 Medicare Physician Fee Schedule), Nicoletti says. “There’s nothing in-between.”

Solution: The AMA slides a service in there with CPT 2008 code 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 new code is for babies who are not normal newborns (99431, 99433) and are not critically ill but sick and less than 28 days,” says Richard A. Molteni, MD, FAAP, an AMA CPT advisory committee member.

Apply 99477 to 3 Scenarios

You’ll use the new code in three situations, says Molteni, who is also a neonatologist and medical director at Children’s Hospital and Regional Medical Center in Seattle. Code 99477 can apply to “babies who are admitted as sick from the delivery room, who were normal newborns and then became sick in the hospital, or who went home and then were readmitted to the hospital and not critically ill.”

“Our neonatologists are looking forward to using this code,” says June M. Gerow, RN, CCP, pediatric reimbursement compliance officer at Golisano Children’s Hospital at Strong in Rochester, N.Y.

Stay tuned: Look for more information from Pediatric Coding Alert with specifics after the CPT codes are published. Plus, educate your staff and bring your questions to The Coding Institute’s live audioconference “2008 Pediatric Coding Update” on Dec. 5 presented by Vicky Varley O’Neil, CPC, CCS-P. Register today at www.audioeducator.com.