Pediatric Coding Alert

Question: For daily hospital rounds when a baby is no longer critical, should I move to hospital codes or to normal newborn codes?

Indiana Subscriber
 
Answer: You should use subsequent hospital care codes (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient ...), as long as the infant weighs more than 2,500 grams. If the newborn is no longer critically ill and weighs 1,500 to 2,500 grams, you should instead assign 99299 (Subsequent intensive care, per day, for the evaluation and management of the recovering low birth weight infant [present body weight of 1500-2500 grams]). For noncritically ill infants who weigh less than 1,500 grams, use 99298 (Subsequent intensive care, per day, for the evaluation and management of the recovering very low birth weight infant [present body weight less than 1,500 grams]).
 
The low and very low birth-weight codes (99298-99299) describe 24-hour global services for neonates who don't meet the critical care definition but require intensive observation and frequent services and interventions consistent with continuing intensive care. Codes 99298-99299 include the same services, such as endotracheal intubation (31500, Intubation, endotracheal, emergency procedure) and continuous positive airway pressure (CPAP) (94660, Continuous positive airway pressure [CPAP] ventilation, initiation and management), that CPT bundles into pediatric and neonatal critical care codes (99293-99296).
 
Don't use the code for subsequent normal newborn care (99433, Subsequent hospital care, for the evaluation and management of a normal newborn, per day) for recovering neonates. Code 99433 describes E/M services for a normal newborn, not a progressing, previously critically ill infant.