Pediatric Coding Alert

Pediatricians who were just beginning to understand the subtleties of coding for critical care services will require a major re-education in 2003 as CPT Codes introduces new codes for pediatric critical care.

The changes outlined in the revised and new critical care codes that impact pediatrics include:
  eliminating the terms "stable" and "unstable," which includes deleting subsequent neonatal intensive care code 99297 adding the "Low Birth Weight Services" subsection, which incorporates the very low-birth-weight code 99298 and new code 99299 restricting patient transport codes to "Pediatric Critical Care Patient Transport." The codes become effective Jan. 1, 2003. Carriers have until April to implement the codes, so check with your payers before using them. To prepare for the new codes, see "Get the Resources You Need for Coding in 2003" on page 91. Neonatal Critical Care:Forget Stable Versus Unstable Pediatricians have struggled for years to understand the difference between subsequent neonatal intensive care for an unstable (99296, Subsequent neonatal intensive care, per day, for the evaluation and management of a critically ill and unstable neonate or infant) and stable (99297, Subsequent neonatal intensive care, per day, for the evaluation and management of a critically ill though stable neonate or infant) neonate. CPT 2003 eases their plight. The subsection "Neonatal Intensive Care" is now titled "Neonatal Critical Care" and includes only two codes: 99295 Initial neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 30 days of age or less
99296 Subsequent neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 30 days of age or less. You should use these codes when the physician provides services for the critically ill neonate through the first 30 days of life, CPT 2003 states on page 21. Report 99295 on the date of admission and 99296 for subsequent inpatient days. These codes are per-day codes, so report only one code per day, per patient. Codes 99295-99296 incorporate the same procedures bundled in the hourly critical care codes (99291-99292): cardiac output measurements (93561-93562) chest x-rays (71010, 71015, 71020) pulse oximetry (94760-94762) blood gases and data stored in computers (99090) gastric intubation (43752, 91105) temporary transcutaneous pacing (92953) ventilatory management (94656, 94657, 94660, 94662) vascular access procedures (36000, 36410, 36415, 36540, 36600). In addition, the codes include the following procedures in the bundled (global) pediatric and neonatal critical care codes: umbilical venous (36510) and umbilical arterial (36660) catheters central (36488, 36490) or peripheral vessel catheterization (36000) other arterial catheters (36140, 36220) oral or nasogastric tube placement (43752) endotracheal intubation (31500) lumbar puncture (62270) suprapubic bladder aspiration (51000) bladder catheterization (53670) mechanical ventilation initiation and management [...]