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:
 

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:

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):

In addition, the codes include the following procedures in the bundled (global) pediatric and neonatal critical care codes:

Codes for Low Birth Weight Refer to Present Weight

When an infant is no longer critically ill but requires intensive care, report the new and revised "Intensive (Non-Critical) Low Birth Weight Services" codes:

Report 99298-99299 for physician services provided subsequent to the admission day. "These codes are present body weight (not birth weight) specific," says Richard Molteni, MD, FAAP, a neonatologist and member of the American Academy of Pediatrics (AAP) national committee on coding and nomenclature (COCN). "The 99298 code is reserved for neonates with a present body weight less than 1,500 grams who continue to require intensive monitoring and management by the physician and the healthcare team," he explains in Coding for Pediatrics 2003, page 174. "The 99299 code will apply to the neonate between 1,500 and 2,500 grams."

The addition of "present body weight" in 99298-99299 clarifies the prior confusion surrounding coding based on weight, adds Richard Tuck, MD, FAAP, medical director of quality care partners for PrimeCare of Southeastern Ohio in Zanesville, and a member of the AAP's COCN. The codes now clearly state to use present body weight rather than birth body weight.

These codes are global 24-hour codes and include the same services outlined under neonatal and pediatric critical care codes 99293-99296, according to CPT 2003.

Critical Care Contains New Section,Two New Codes

Pediatricians will have two codes for initial and subsequent pediatric critical care services for patients 31 days through 24 months of age:

These codes are global codes, so you should report one code per day in addition to any nonbundled services. Codes 99293-99294 include the same critical care services as outlined in the neonatal critical care section above. If a baby transfers from before 30 days of age to more than 30 days of age while in critical care, the coding should change from 99296 to 99294 per day to reflect the age change, Tuck says.

The new section allows for continuous coding of the very low-birth-weight neonate who still requires critical care services at or beyond 30 days of postnatal life, according to Coding for Pediatrics 2003. These codes should also be used for any child age 2 years or less requiring critical care, not 99291-99292 (Critical care) as previously coded, Tuck notes.

CPT Places Restrictions on Patient Transport Codes

In CPT 2003, the "Patient Transport" subsection is renamed the "Pediatric Critical Care Patient Transport," which makes the codes age- and care-specific. CPT limits the 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]) to pediatric patients who are 24 months or less. The codes did not previously have any age restrictions.

The revised definitions state "face-to-face" physician contact. CPT 2002 previously buried this requirement in the subsection's language and did not include it in the code's definitions. Codes 99289-99290 now provide clear beginning and end times for the face-to-face service, states CPT Changes 2003: An Insider's View.

CPT 2003 also replaced the phrase "physician constant attention of the critically ill or injured patient" with "critical care services delivered by a physician." The AMA has redefined the transport codes "as critical care with bundled procedures," says John P. Crow, MD, APSA (American Pediatric Surgical Association), Pediatric and Neonatal Coding 2003 presenter at the AMA CPT Symposium in Chicago on Nov. 14.

To reflect the shift to critical care services, according to CPT Changes 2003, the codes have been revised to:

You should separately report any services performed that are not listed as bundled in the critical care codes, CPT states. These codes require a minimum of 30 minutes service time. If the physician does not perform 30 minutes of critical care, report the services/procedures with the appropriate E/M code, Tuck says.