Primary Care Coding Alert

Experts reveal how 3 revised instructions will simplify your 99289-99296 options

If critical care codes confuse you, you'll welcome CPT 2004's new guidelines that clarify some of your major neonatal and pediatric coding dilemmas.
 
Starting Jan. 1, 2004, coding experts recommend that you bill for critical care services based on the following three guidelines.

1. For Outpatient Critical Care, Assign 99291-99292

The biggest pediatric change for 2004 specifies that you should assign 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]) for all outpatient critical care services, says Linda J. Walsh, MAB, healthcare finance and practice senior health policy analyst manager in Elk Grove Village, Ill. "The patient's age no longer matters."
 
You may report 99291-99292 in the following locations: the office (place-of-service code 11), urgent care facility (POS 20), pediatric outpatient floor (POS 22, outpatient hospital), hospital emergency room (POS 23) and ambulance (POS 41, land; POS 42, air or water), says David G. Jamiovich, MD, transportation code creator and pediatric transport program medical director at Hope Children's Hospital in Oak Lawn, Ill.

2. Reserve 99293-99296 for Inpatient Critical Care

If you struggle with coding for outpatient critical care services that result in transfers of care, CPT's critical care revision simplifies your options, Jamiovich says. When your family physician (FP) provides outpatient critical care services to a patient prior to sending the patient to a specialist for inpatient services, you should report 99291-99292, Fick says. The specialist, such as a neonatologist, would then report the global neonatal (99295, Initial inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 30 days of age or less; 99296, Subsequent inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate; 30 days of age or less) or pediatric (99293, Initial inpatient pediatric critical care, 31 days up through 24 months of age, per day, for the evaluation and management of a critically ill infant or young child; 99294, Subsequent inpatient pediatric critical care, 31 days up through 24 months of age, per day, for the evaluation and management of a critically ill infant or young child) critical care codes.
 
For instance, a mother presents to an FP's office with her 6-month-old son, who has diarrhea (787.91) and dehydration (276.5). While the mother is waiting for her appointment, the infant goes into hypovolemic shock (785.59). The FP provides one hour of in-office critical care prior to a transport team arriving to transfer the infant to an intensive care unit. For the outpatient critical care, you should report 99291. The receiving physician will assign initial inpatient pediatric care (99293).
 
But, if the FP also provides the inpatient critical care, you shouldn't report the outpatient services. Instead, you should roll the outpatient E/M (99291) into the inpatient service (99293), CPT states.

3. Use 99291-99292 for 'Adult' Interfacility Transport

 The revised critical care guidelines answer a common pediatric question: What code should you use for interfacility transports of children over 2 years of age? "As long as your FP accompanies the child in the transport vehicle, CPT 2004 specifies that you should use 99291-99292," Jamiovich says.
 For patients who are 24 months of age or less, you should use pediatric critical care patient transport codes (99289, 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; +99290, ... each additional 30 minutes ...).