Wiki Newborn Critical Care and Transfer to Other Facility

[hblawless]

Problem: Newborn in one facility and transfer to another facility.
Newborn with documented abdominal mass at birth requires further treatment in NICU setting and is transferred to other facility.
Attendance at Delivery for initial stabilization. No immediate threat by observation for mass screen in prenatal screen and upon birth.
Newborn, after consultation with NICU facility and determined transfer for additional testing and possible surgery was necessary.

CPT reflects to transfer care from facility to facility this should be coded as 99464 and 99291 (critical care)
Physician documentation does not include time allotted for the critical care.

CPT documentation not clear for this scenario.

How should this be coded?
Is this Critical Care?
What documentation should be identified for critical care?

 

[meghanhannus]

Hello hblawless,

The documentation that you have provided does not support Critical Care as time is not documented nor is a critical illness or injury that acutely impairs one or more vital organ systems of the newborn for example respiratory failure,CNS failure, renal failure etc.... I believe in order to code CPT 99464 you would need the delivery record with the provider attesting/signature stating they were present during the delivery for initial stabilization and also the delivering physician or other qualified health care professional would have to request the service from this provider. Do you have any other documentation from the delivering provider to try and piece this together? Otherwise, I could be wrong but it does not seem like this is a billable service at all. It does not support any key components of an inpatient subsequent e/m either. It just seems like an overview of what the plan of course will be for the newborn.


M.Hannus, CPC, CPMA, CRC