Pediatric Coding Alert

Question: My pediatrician admits a 37-week-old child to a neonatal intensive care unit where he administers continuous positive airway pressure (CPAP) and orders chest x-rays. Should I charge the hourly or global critical care code?

Oklahoma Subscriber

Answer: Because the child is under 24 months of age, you should report the global critical care code based on the child's age, rather than the "adult" hourly critical care codes, such as 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and +99292 (... each additional 30 minutes [list separately in addition to code for primary service). For a child aged 31 days through 24 months of age, as in your example, you should report 99293 (Initial pediatric critical care, 31 days up through 24 months of age, per day, for the evaluation and management of a critically ill infant or young child). If the neonate is 30 days of age or less, use 99295 (Initial neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 30 days of age or less). You should report each subsequent day of critical care with 99294 (Subsequent pediatric critical care, 31 days up through 24 months of age, per day, for the evaluation and management of a critically ill infant or young child) for pediatric patients and 99296 (Subsequent neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 30 days of age or less) for neonates.

Remember that all critical care codes (99291-99296) include chest x-rays (71010, Radiologic examination, chest; single view, frontal; 71015, ... stereo, frontal; 71020, Radiologic examination, chest, two views, frontal and lateral). The neonatal and pediatric critical care codes (99293-99296) also include CPAP (94660, Continuous positive airway pressure ventilation [CPAP], initiation and management).

Even though charging initial pediatric critical care (99293) means that you shouldn't charge for the CPAP (94660 pays over $36.79), billing 99293 will pay significantly more than the first hour of adult critical care. Code 99293 pays over $803.13, compared to $200.14 for 99291 and $100.70 for 99292.