Pediatric Coding Alert

The neonatal intensive care codes (99295-99298) will be altered and added to in 2003.

One Code for Stable and Unstable

 
A new compressed code will combine 99296 (Subsequent neonatal intensive care, per day, for the E/M of a critically ill and unstable neonate or infant) and 99297 (Subsequent neonatal intensive care, per day, for the E/M of a critically ill though stable neonate or infant) and eliminate references to stable and unstable.
 
"There were no objective guidelines to what defined stable and unstable," explains Linda Walsh, senior health policy analyst with the AAP division of healthcare finance and practice. Some pediatricians were undercoding with 99297 even when 99296, which pays more, was more appropriate. There were also questions about how to define "critically ill though stable" versus "critically ill and unstable."

Two Body-Weight Codes

 
CPT Codes 2002 will add two body-weight codes: a low-body-weight code, a sister code to 99298 (Subsequent neonatal intensive care, per day, for the evaluation and management of the recovering very low birth weight infant [less than 1500 grams]) that will be for 1,501-2,500 grams and one for up to 1,500 grams, Walsh says.
 
It will be clear in the new definitions that both codes are for current body weight, not birth weight. The definition now refers to birth weight.
 
Once the baby reaches 2,500 grams, subsequent hospital care codes are used. If five days later the baby loses weight, coding can return to the neonatal intensive care low-body-weight code.

31 Days to 2 Years Old

 
For the first time, there will also be pediatric intensive care codes one initial, one subsequent which will be used for all babies once they reach the age of 31 days. For example, if a newborn is admitted critically ill to the neonatal intensive care unit (NICU), the initial and subsequent neonatal intensive care codes will be used until the age of 31 days. If the baby is still critical at 31 days, the new pediatric intensive care codes will be used even though the baby remains in the NICU.
 
Neonatal intensive care codes in 2003 will include:
 

an initial neonatal intensive care code for the day of admission of a critically ill neonate under age 31 days
 

a subsequent neonatal intensive care code for subsequent days, for a critically ill neonate under age 31 days
 

a low-body-weight code for infants not critically ill, with a current body weight of less than 1,500 grams
 

a low-body-weight code for infants not critically ill, with a current body weight of 1,500-2,500 grams
 

an initial pediatric intensive care code for the day of admission of a critically ill infant or child between the ages of 31 days and 2 years
 

a subsequent pediatric intensive care code for subsequent days, for a critically ill infant or child between the ages of 31 days and 2 years.