Pediatric Coding Alert

Question: What services are included in the new neonatal initial hospital intensive care code, 99477?North Carolina Subscriber

Answer: Many of the same services that CPT includes in neonatal and pediatric critical care (99293-99296) are also included in 99477. The same bundles also apply to initial and subsequent intensive care codes (99298-99300, 99477).

Numerous services are inherent in 99477. When using 99477, you cannot separately bill these items:

• umbilical venous (36510) and umbilical arterial catheters (36660)

• other arterial catheters (36140, 36620)

• central (36555) or peripheral vessel catheterization (36000)

• vascular access procedures (36400, 36405, 36406)

• vascular punctures (36420, 36600)

• oral or nasogastric tube placement (43752)

• endotracheal intubation (31500)

• lumbar puncture (62270)

• suprapubic bladder aspiration (51100)

• bladder catheterization (51701, 51702)

• ventilatory management (94002-94004)

• CPAP (94660)

• Surfactant administration (94610)

• transfusion of blood components (36430, 36440)

• invasive or noninvasive electronic monitoring of vital signs, bedside pulmonary function testing (94375)

• monitoring or interpretation of blood gases or oxygen saturation (94760-94762).

The above list includes two changes from 2007 critical care bundles:

1. Aspiration code updated: The suprapubic bladder aspiration inclusion reflects CPT renumbering this procedure as 51100 instead of 51000.

2. Hydration codes added: In addition, the bundles now include 90760-90761. CPT 2008 does not allow the physician in a facility (hospital setting) to report 90760-90761.

Expect more: Private payers that adopt Correct Coding Initiative (CCI) edits may subject 99477 to additional bundles. CCI version 14.0, effective Jan. 1, bundles new neonatal initial hospital care code 99477 into a whopping 418 codes, says Frank Cohen, CMPA, CPA, of Health Partners in Clearwater, Fla. If you report 99477 with individual psychotherapy codes 90804-90828, therapy evaluation/re-evaluation codes 97001-97004, or scores of anesthesia or radiology codes, CCI-adherent payers will deny 99477. And 141 other codes (including almost all of the E/M codes) bundle into 99477 and are therefore not separately payable if you report them with neonatal initial hospital care.