Wiki Transport of non-critical & critical of neonate questions

[KSanders01]

We are a group of private NICU physicians who service multiple hospitals. Recently our Doctors have been sent on transports by the hospital because they reportedly don't employ staff trained qualified to care for newborns in transport. We are NOT billing for these and the hospital is NOT paying us for this, so we are wanting to try and bill insurance. I have a few questions....

1. We can bill for CPT 99466 & 99468 on the same day correct?
1. Is there a code for non-critical transport of a neonate? We accompany newborns who are stable but need to move to a different facility for surgery, etc. Is this billable along with our non-critical daily charges? I can't find a code for this....any suggestions?
2. What are the documentation/ risk management guidelines we should be following for these trips? We have never treated patients outside of the hospital before so this is new to us. Would we use Modifier 41?
3. We had a APRN sent to a delivery an hour away for a delivery and planned pick-up of an "extremely pre-term baby" (delivering hospital doesn't have a NICU or neonatologists.) The baby was born healthy and full term so we weren't needed. She spent 8 hours total between the drive and waiting at the hospital...is there a "stand-by" code or something else we could use for this?
Thank you!

 

[CBLENNIE]

I work for an insurance company so my responses are going to be based on how an insurance company might consider the claim scenarios you posed.

1. 99468 has a note to "code also interfacility critical care transport services by same or different provider, same or different specialty group, same date (99466-99467, 99485-99486)", so you should be able to bill 99466 & 99468 on the same DOS as long as the services are documented and meet the criteria of being medically necessary services. Additionally, there are no codes for accompanying a non-critical neonate during transportation, and most insurance companies would not consider this service medically necessary. In theory the ambulance company should have staff trained to manage the care of the majority of types of patients they transport or should be responsible for paying for a physician to accompany a non-critical neonate if they don't have staff who can provide care to this type of patient.
2. There is no modifier 41, are you by chance referring to using POS code 41-Ambulance, Land? You would use POS 41 for the transport CPT codes 99466 & 99467.
3. In theory you could bill 99360-Standby service, requiring prolonged attendance, each 30 minutes (e.g., operative standby, standby for frozen section, for cesarean/high risk delivery, for monitoring EEG) for the time the APRN was at the facility where baby was born, although most commercial insurance companies do not cover this service. As for the time the APRN spent traveling to/from the facility where the baby was born, there are no CPT or HCPCS codes that I could find to bill for the APRNs travel time, all of the codes were related to transportation and/or escorting a patient.

 

[KSanders01]

I work for an insurance company so my responses are going to be based on how an insurance company might consider the claim scenarios you posed.

1. 99468 has a note to "code also interfacility critical care transport services by same or different provider, same or different specialty group, same date (99466-99467, 99485-99486)", so you should be able to bill 99466 & 99468 on the same DOS as long as the services are documented and meet the criteria of being medically necessary services. Additionally, there are no codes for accompanying a non-critical neonate during transportation, and most insurance companies would not consider this service medically necessary. In theory the ambulance company should have staff trained to manage the care of the majority of types of patients they transport or should be responsible for paying for a physician to accompany a non-critical neonate if they don't have staff who can provide care to this type of patient.
2. There is no modifier 41, are you by chance referring to using POS code 41-Ambulance, Land? You would use POS 41 for the transport CPT codes 99466 & 99467.
3. In theory you could bill 99360-Standby service, requiring prolonged attendance, each 30 minutes (e.g., operative standby, standby for frozen section, for cesarean/high risk delivery, for monitoring EEG) for the time the APRN was at the facility where baby was born, although most commercial insurance companies do not cover this service. As for the time the APRN spent traveling to/from the facility where the baby was born, there are no CPT or HCPCS codes that I could find to bill for the APRNs travel time, all of the codes were related to transportation and/or escorting a patient.

Corinne, thank you for the clarification and answers to all my questions. You were correct on the pos 41- for ambulance, that was what I was looking for confirmation of mainly. I will look into the standby codes. I appreciate your help so much!