Get Paid for Visits to the NICU
Published on Fri Mar 01, 2002
Premature infants who require extended stays in neo-natal intensive care units (NICUs) are usually seen by neonatalogists for their critical care needs. In some cases, when a premature infant is in severe respiratory distress, a pediatric pulmonologist is called in. "On occasion they are consulted," says Terrence Zach, MD, neonatologist, Creighton University, Omaha, Neb. "When we consult with a pulmonologist, it is usually for a baby who has a very unusual lung disorder or complication, not for the more common 'preemie lung disease.' "
Background on Neonatal Intensive Care Codes
The physician who provides the overall care and management of the infant or neonate in the NICU uses the neonatal intensive care codes (99295-99298). These codes are not based on the type of provider (e.g., pediatrician, neurologist, pulmonologist). It is possible that a pulmo-nologist could assume the complete and total care of the infant in the NICU. For example, if the pulmonologist is covering for another physician, he or she would use
99295-99298:
99295 Initial neonatal intensive care, per day, for the evaluation and management of a critically ill neonate or infant
99296 Subsequent neonatal intensive care, per day, for the evaluation and management of a critically ill and unstable neonate or infant
99297 ... of a critically ill though stable neonate or infant
99298 ... for the evaluation and management, of the recovering very low birth weight infant (less than 1500 grams).
If the infant is 30 days old or younger, the neonatal codes apply. These codes can be used until the child is discharged, or as long as the infant is critically ill. Once the infant reaches a weight of 1,500 grams or more and is not critically ill, subsequent hospital care codes (99231-99233) are appropriate.
Codes 99295-99298 differ from critical care codes (99291-99292) which are time-based. For example, 99291 is for the 30-74 minutes of critical care and is used once per day. Code 99292 is for each additional 30 minutes. These codes cannot be used for an infant in the NICU.
In addition, neonatal intensive care codes are bundled with many procedures, but critical care codes are not. Such procedures may include ventilator initiation and manage-ment (94656-94657), intubation (31500) and oral or nasogastric tube placement (91105).
Coding in the NICU
A neonatologist calls in a pediatric pulmonologist to determine if the infant is suffering from subglottic stenosis (478.74). Since the pulmonologist is not assuming the overall care of the infant, NICU codes would not apply. Instead, use an initial inpatient consult code (99251-99255), a code for the diagnostic and treatment procedures, diagnosis, and subsequent hospital care codes if appropriate.
The following is an NICU scenario: The infant has been in the NICU on a ventilator for a month and has failed several [...]
