Pediatric Coding Alert

Question: There's a notation in the CPT 2009 manual that the neonatal critical care codes include delivery room resuscitation. Is this true?

Illinois Subscriber

Answer: No, a parenthetical note following 99465 (Delivery/birthing room resuscitation, provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output) incorrectly stated that resuscitation could not be reported with other per day critical care services, said Peter A. Hollmann, MD,AMACPT editorial panel vice chair in the "Evaluation and Management" session at the AMACPT and RBRVS 2010 Annual Symposium in Chicago on Nov. 12. You can separately report 99465-25 (Significant, separately identifiable evaluation and management service provided by the same physician on the same day of the procedure or other service) provided the resuscitation in the delivery room is provided as a medically necessary service and not as a convenience prior to admitting the patient for critical care (99468, Initial inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or younger) or intensive care (99477, Initial hospital care, per day, for the evaluation and management of the neonate, 28 days of age or younger, who requires intensive observation, frequent interventions, and other intensive care services).

An errata published on the AMAWeb site listed this error in January 2009.

But the printed incorrect instruction that appeared in the CPT 2009 manual caused confusion for Medicaid contractors, payers, and coders alike.

Good news: "In CPT 2010, the AMA corrects that instruction," Hollmann says. Code 99465's revised note indicates "99465 may be reported in conjunction with 99460, 99468, 99477."

-- Information and/or answers to You Be the Coder and Reader Questions reviewed by Richard Tuck, MD, FAAP, pediatrician at PrimeCare of Southeastern Ohio in Zanesville.