Pediatric Coding Alert

This directive stops the sending physician from committing an $860 global critical care error.If both the sending and receiving physician bill for same-day global critical care, you could put your claim on the path to denial -- costing one physician $860 in pay.CPT 2009 throws neonatal inpatient coding a curve ball. Make sure your transport and discharge reporting skills are up to par with this quiz.2 NICU/ICU Global Codes = 1 DenialQuestion: One physician admits a newborn to a hospital. The newborn is then transferred to a different hospital where another physician sees the newborn. Both physicians used 99295.The insurer paid the first 99295 but denied the second physician's 99295 as duplicate. Does a modifier apply?Both physicians should not report per diem codes. "The wording in CPT 2009's 'Pediatric Critical Care Patient Transport' notes makes that clear," says Richard A. Molteni, MD, a neonatalogist at Seattle Children's Hospital.Breakdown: If a physician at a sending hospital provides critical care before the patient is transferred to another facility, the sending physician should use time-based hourly critical care codes (99291, Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes; +99292, ... each additional 30 minutes [List separately in addition to code for primary service]). The physician at the receiving hospital who provides critical care to the patient for the remainder of the day reports the per diem or global critical care code as follows:• For neonatal critical care, use 99295 in 2008, and in 2009 report 99468 (Initial inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or less).• For a patient who is age 2 to 5 years of age and requires critical care, report pediatric critical care in 2009 with 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).Here's how CPT's directive applies to critical care services in the same facility but in different settings:• If a physician provides critical care services to a patient in the emergency department (ED), which is an outpatient setting, and then a different physician in another group admits the patient to critical care, the physician providing the services in the ED would bill the hourly critical care (99291, +99292) and the admitting physician in another group would bill the global critical codes (99468, 99475).• If the same physician provides outpatient and inpatient critical care in both settings, report only the global care code for all critical care services the physician provides that day.Reason: No two physicians can both claim same-day per day critical care, which 99295/99468, 99475 represent, for the [...]