Pediatric Coding Alert

Question: A pediatrician admitted a critical newborn and put the baby on continuous positive airway pressure (CPAP) initially but had to use Neopuff bagging during the computed tomography (CT) for the baby because the staff had to take the CPAP off during the scan. The baby was transferred out the same date, so I am billing hourly critical care for the physician, not the daily critical care (CC). Is the Neopuff a separately billable charge?

Michigan Subscriber

Answer: Do not separately report the Neopuff. "The Neopuff represents ventilatory management like CPAP or SIMV (synchronized intermittent mandatory ventilation) and is documented in the hourly critical care codes," says Gilbert I. Martin, MD, FAAP, neonatal intensive care unit (NICU) director at Citrus Valley Medical Center in West Covina, Calif. The hourly critical care codes (99291, Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes; and +99292, ... each additional 30 minutes [List separately in addition to code for primary service]) include the ventilator management codes (94002-94004, 94660, 94662), which includes CPAP (94660, Continuous positive airway pressure ventilation [CPAP], initiation and management).

Provided the pediatrician attended the delivery, you can assign 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) for the delivery room provision of ventilation and 99291 for the first 30-74 minutes of critical care time spent with the patient.

To indicate the critical care is significant and separate from the delivery room procedure, append 99291 with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). If the pediatrician did not attend the delivery, you would use only 99291.

Don't miss: If the physician went on the transport to the second hospital and provided face-to-face contact with the patient, then you could use the transport codes:

• 99466 -- Critical care services delivered by a physician, face-to-face, during an interfacility transport of critically ill or critically injured pediatric patient, 24 months of age or less; first 30-74 minutes of hands-on care during transport

• +99467 -- Critical care services delivered by a physician, face-to-face, during an interfacility transport of critically ill or critically injured pediatric patient, 24 months of age or less; each additional 30 minutes (List separately in addition to code for primary service).