Pediatric Coding Alert

Question: A pediatrician sees an 8-year-old patient in the pediatric intensive care unit. For the first three hours, I am using 99291 and 99292 x 4. On the following five days, the pediatrician sees the patient in the PICU for critical care. The doctor wants to use 99293 and 99294 for these five days, but the patient is not 24 months old or younger. What CPT codes should I report?

Answer: You are correct in coding three hours of critical care services with 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and +99292 x 4 (... each additional 30 minutes [list separately in addition to code for primary service]). For critical care of a patient older than 24 months of age, you are limited to using these hourly critical care codes. If the pediatrician documented the time she spent providing critical care services to the patient on the additional five days, you should use 99291 for the first hour and 99292 for each additional 30 minutes.

If the patient does not meet the definition of critically ill, you should instead use the subsequent hospital care codes (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient ...). Remember when using 99231-99233, you can separately code procedures provided as well as prolonged services time (99356-99359) if indicated.

Do not use 99293-99294 for a child older than 24 months of age. Codes 99293 (Initial inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 29 days through 24 months of age) and 99294 (Subsequent inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 29 days through 24 months of age) are 24-hour global codes for patients between 29 days and 24 months of age.