Wiki Pediatric critical care in observation

[kimsue63]

Just trying to get some definite opinions/answers on this before I go back to the physicians.....if the pediatric patient is in "observation" status we can't use the pediatric critical care codes (99472-99476) because observation is considered outpatient; we must use the 99291-99292 codes. Am I correct?

 

[OCD_coder]

None of the Critical Care codes are point of service driven, they are acute care codes. If the patient's location is in outpatient status and they are of pediatric age, you would use the pediatric critical care codes with outpatient point of service indicator.

99291-99291 are not used for pediatric patients.

 

[kimsue63]

But the CPT description of the pediatric critical care codes does say "inpatient"; and the description for 99291-99292 states these codes are to be used for the pediatric patient in an outpatient setting....

 

[shellysk8]

99291-2

I'm with you. The pediatric critical care codes should only be used for inpatient. 99291-2 are no longer dictated by age in their CPT description and can be used for pediatric outpatient/ED services. Once admitted, the peds codes should be used instead.

Thanks,
Shelly

 

[Cynthia Hughes]

Agree. Critical care in observation status is reported with codes 99291-99292. If the same physician provides pediatric critical care to a patient less than 6 years of age in the outpatient setting and then later on that date in the inpatient setting, report only the inpatient pediatric critical care codes as these codes include all critical care services on that date.

Cindy