Pediatric Coding Alert

CPT 2006 expands subsequent care codes to include normal-weight newborn

Knowing the new 2006 method for reporting subsequent intensive care of a noncritically ill normal-weight infant should pay you $100 more than the 2005 method.

In addition to adding several editorial notes to critical care services, CPT 2006 revamps the intensive care subcategory and adds one new code. To ensure correct coding of these services when the changes become effective Jan. 1, educate yourself and your coding staff on these fundamentals. 1. Transition From 99300 to 99231-99233 You should add a new code to the coding continuum of care for sick babies. "Code 99300 finishes the continuum of managed care for patients who require enhanced observation and monitoring," says Richard A. Molteni, MD, FAAP, the American Academy of Pediatrics representative to the AMA CPT advisory committee. When a noncritical newborn weighs more than 2,500 grams, you can now continue to use intensive care codes.

Old method: "In 2005, you would have reported subsequent intensive care of a non VLBW/LBW newborn with subsequent hospital care codes," says Molteni, who is also a neonatologist and medical director at Children's Hospital and Regional Medical Center in Seattle. When a noncritical infant who had been previously critically ill had a present body weight of 2,501 grams or more, you had to switch from 99299 (Subsequent intensive care, per day, for the evaluation and management of the recovering low birth weight infant [present body weight of 1500-2500 grams]) to 99231-CPT 99233 (Subsequent hospital care, per day, for the evaluation and management of a patient ...). Intensive (non-critical) low birth-weight service codes ended when the infant exceeded 2500 g.

New way: To capture care of a newborn weighing 2,501-5,000 grams, CPT 2006 creates continuing intensive care code 99300, which describes "Subsequent intensive care, per day, for the evaluation and management of the recovering infant (present body weight of 2501-5000 grams)."

"The new intensive care code doesn't require the newborn to be very low or low birth weight (VLBW/LBW)," says Patricia S. Wildman, RHIA, CCS-P, clinical reimbursement auditor in the compliance department at Children's Hospital Boston.

On claims for 2006, when an infant who requires intensive care weighs more than 5,000 g (about 11 pounds), you'll switch from 99300 to 99231-99233. The new coding continuum is contained in the chart included with this article:

Heads up: Failing to incorporate the new code could cut almost $100 from a claim. For instance: If you report subsequent intensive care (SIC) of a recovering 3,500-g infant with 99233 instead of 99300, you'll receive $54.54 instead of $149.16, based on the 2006 National Physician Fee Schedule. The fee schedule, which uses a conversion factor of 36.1171, assigns:

• 2.09 relative value units to 99233
• 5.64 RVUs to 99300. 2. [...]