Wiki Critically ill newborn coding for time?

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debellis59

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I have a newborn who is critically ill after meconium aspiration. He was eventually transferred to the local University hospital, but in the meantime, the provider spent six hours, managing respiratory support, cardiac work up (murmur), collaborating with the NICU at the University hospital. I'm unsure how to code for this much time. 99468 doesn't seem adequate. Is it appropriate to use 99291 with 99292 x9?

Any help anyone can provide would be great. I've not ever run across this before. Usually they are transferred right away. But this was the middle of the night, so it crossed from one day to the next ... If that makes a difference? And do I code it for both days or just the initial?

Thank you!
 
Neonate critical care (0-28 days) is not coded by time. The cpts used are 99468-99469. The 99291, etc codes are for pediatric critical care cases 6 years of age and up. Regardless of how much time was spent stabilizing the newborn, the 99468 is a bundled service and is indeed adequate for this case. Hope this helps!
 
Your physician is the transferring physician so time-based codes are appropriate per CPT as long as the receiving physician at the University hospital is in a different group practice or of a different specialty. The guidelines for the neonatal codes say that when critical care services are provided to neonates at two separate facilities by an individual from a different group on the same date of service, the individual from the referring institution should report their critical care services with the time-based critical care codes (99291, 99292) and the receiving institution should report the appropriate initial day of care code 99468 for the same date of service.

Hope that helps.
Cindy
 
Cynthia Hughes said:
Your physician is the transferring physician so time-based codes are appropriate per CPT as long as the receiving physician at the University hospital is in a different group practice or of a different specialty. The guidelines for the neonatal codes say that when critical care services are provided to neonates at two separate facilities by an individual from a different group on the same date of service, the individual from the referring institution should report their critical care services with the time-based critical care codes (99291, 99292) and the receiving institution should report the appropriate initial day of care code 99468 for the same date of service.

Hope that helps.
Cindy
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Thank you. The provider works for both facilities. So, I guess I go with 99468. Thank you so much.
 
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