Pediatric Coding Alert

Question: The January 2006 Pediatric Coding Alert indicates that when an infant requires intensive care and weighs more than 5,000 grams (about 11 pounds), I  should switch from 99300 to 99231-99233. But what if the initial day involves an admission?


Virginia Subscriber

Answer: For encounters involving intensive care on subsequent care days, you should transition from 99300 (Subsequent intensive care, per day, for the evaluation and management of the recovering infant [present body weight of 2501-5000 grams]) to 99231-99233 (Subsequent hospital care, per day, for the evaluation and management of a patient …).

If the pediatrician admits a noncritical, intensive care infant on day 1 and provides subsequent care on day 2, you should assign initial hospital care for the first day. The infant’s weight will determine which code you should assign for day 2. If the infant weighs 5,000 g or less, assign new subsequent intensive care code 99300. For a patient who surpasses this weight threshold, you should instead use the appropriate subsequent care code (99231-99233).

Although the chart in the article that you refer to shows the applicable code sets based on a newborn’s condition, you may want to further break down the codes based on service date. To report services with this added specificity, use this chart:

Correction: The January 2006 Pediatric Coding Alert article “Update Neonatal Care Continuum With New High-Paying SIC Code” also used an incorrect 2006 conversion factor. The figures should have reflected a cut of almost $125 as opposed to $100 based on a tentative CF of 36.1770, not 36.1171. The pay loss comes from incorrectly using 99233 (2.09 relative value units x 36.177 = $75.61) instead of 99300 (5.64 RVUs x 36.1171 = $203.70).  

Stay tuned: The CF for 2006 of 36.1770 may be short-lived. Because the U.S. Congress did not pass legislation to freeze the CF at 2005’s rate of 37.8975--or to alter the rate--the decreased rate became effective Jan. 1. When Congress reconvenes this winter, the Senate and House will have to sort out their budget bill disagreements, which include a possible 1 percent rate hike that would offset the CMS current rate cut of 4.4 percent for 2006.

Answers to You Be the Coder and Reader Questions provided by Barbara J. Johnson, CPC, MPC, owner of Real Code Inc. in Moreno Valley, Calif.; Jack Percelay, MD, MPH, FAAP, pediatric hospitalist with the Virtua Health System in southern New Jersey; and Deborah F. Rushing, CPC, a coding specialist at Management Consultants for Affiliated Physicians (MCAP), which serves neonatologists in Virginia.