Wiki Pediatric Critical Care

[pglazener]

I need help explaining the paragraph in CPT that states: "When the critically ill neonate or pediatric pt imporves and is transferred to a lower level of care to another individual in another group withing the same facility, the transferring individual doe snot report a per day critical care service. Subsequent hospital care (99231-99233) or time-based critical care service (99291-99292) is reported, as appropriate based upon the conition of the neonate or child."

The intensivist is interpreting it to mean that no matter the age of the child, if the condition improves but still warrants critical care, he is to use 99291-99292.

My confusion is why would a critically ill patient be transferred to the floor out of ICU? Any thoughts opinions would be appreciated.

 

[Cynthia Hughes]

If the child is critically ill or injured for a time on that day but later that day improves (no longer requiring critical care) and is transferred to a lower level of service and a physician in another group, the transferring physician bills only for the hourly critical care prior to the improvement and transfer. If the child required less than 30 minutes of critical care on that date, subsequent hospital care would be reported by the transferring physician. That receiving physician might report intensive care or subsequent hospital care depending on the age of the patient and type of care required. Does that help?