Pediatric Coding Alert

Question: When caring for a high-risk newborn who is transferred to another facility, is it better to code the procedures separately or to use the neonatal intensive- care codes?

Ohio Subscriber
 
Answer: The intent of CPT is to include procedures on critically ill infants in neonatal intensive-care codes, 99295-99298. For infants who are transferred and critically ill, however, there is the option to code with either the individual procedures or 99295 (initial neonatal intensive care, per day, for the evaluation and management of a critically ill neonate or infant). To determine which is best, you need to add the relative value units (RVUs) for the procedures and see if the total is greater than the neonatal intensive-care code you would use.
 
As an example, a pediatrician was called to a vaginal delivery of a baby who has thick particulate meconium on arrival. The obstetrician suctioned the baby, but the baby was pale and limp. The pediatrician visualizes the cord by laryngoscopy (31500, intubation, endotracheal, emergency procedure) and sees no meconium below the cord. The baby's color improves with positive pressure ventilation, but there remains some respiratory distress. The pediatrician initiates CPAP (94660, continuous positive airway pressure ventilation [CPAP], initiation and management) and orders blood tests.
 
The pediatrician then places a UAC (36660, catheterization, umbilical artery, newborn, for diagnosis or therapy) or a UVC (36510, catheterization of umbilical vein for diagnosis or therapy, newborn) and, later, discusses the case with a neonatologist at a children's hospital for transfer. Finally, the pediatrician starts IV antibiotics and prepares the baby for air evacuation. The time spent with the newborn is four hours in intensive care, with a final diagnosis of meconium aspiration syndrome.
 
If the pediatrician were to code the procedures individually, he or she would report 99223 (initial hospital care, per day; 4.20 RVUs), 99436 (attendance at delivery [when requested by delivering physician] and initial stabilization; 2.42 RVUs), 31500 (3.29 RVUs), either 36660 (1.96 RVUs) or 36510 (1.70 RVUs), 94660 (1.48 RVUs), 99356 (prolonged physician service in the inpatient setting requiring direct [face-to-face] patient contact beyond the usual service [e.g., maternal fetal monitoring for high risk delivery or other physiologic monitoring, prolonged care of an acutely ill inpatient]; first hour) (2.45 RVUs), and 99357 ( each additional 30 minutes) x 4 (2.47 x 4 RVUs). The RVU total is 25.68 if an arterial line (36660) is used, or 25.42 if a venous line (36510) is used.
 
The alternative is to code 99295 (21.72 RVUs) and 99436 (2.42 RVUs), for a total of 24.14 RVUs.
 
Therefore, in the above example, coding the procedures would pay better than the neonatal intensive-care code. In addition to coding based on which set of codes yields the highest number [...]