Pediatric Coding Alert

Reader Question:

Neonatal Critical Care

Question: A baby developed problems several days after birth. The pediatrician transferred the newborn to the neonatal intensive care unit (NICU) in the middle of the night, but the baby remained with the pediatricians service. How should we bill for the next days visit and subsequent visits? Also, if a baby who has been in the NICU is transferred from neonatology back to the pediatric service, is this billed as a consult?

Florida Subscriber

Answer: If the child is critically ill and transferred to the NICU but the services are provided by the original pediatrician, the neonatal critical care code (99295) applies. This is a daily, global code that covers essentially all the procedures performed in a NICU.

If the baby continues to be critically ill and remains in the NICU, then 99296-99298, subsequent day neonatal intensive care codes, are used for each following day. If the infant transfers from the NICU neonatology service to a general pediatric service, then use codes 99231-99233 (subsequent hospital care).

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