Contemporary Pediatrics - September 2008 - (Page 124)

R for a Healthy Practice x Discourse on the business of medicine Use new intensive care code 99477well fast for babies who get BY ALISON INSINGER N ew neonatal intensive care code 99477 fills an important gap between critical care (99295) and regular hospital admission (99221-99223) codes. Code 99477 (initial hospital care, per day, for the evaluation and management of the neonate, 28 days of age or less, who requires intensive observation, frequent interventions, and other intensive care services) will typically be used for babies who need intensive care on the first day of admission, but normal levels of care by the second, according to Richard A. Molteni, MD, a neonatologist with the American Medical Association (AMA) CPT Advisory Committee. “I suspect that we will see use of this code at birth for babies with mild respiratory distress or who are a little ‘shocky,’” Molteni says. “Some of these babies may become truly critical, but the majority will be sick and then get better.” services, see 99221-99223 Coding for second day of care after use of 99477 would follow these guidelines: • Subsequent critical care code 99296 would be used for babies who start out qualifying for services described in 99477, but become critical • Subsequent hospital codes 99231-99233 would be used for babies who are still sick, but don’t require intensive services after the initial day of 99477 • Subsequent normal newborn code 99433 would be used for babies who get well after the initial day of 99477 (Note: Subsequent days with continuing intensive care services would be reported with 99298-99300 only if the baby weighed 5,000 grams or less [99300, according to CPT].) New code better reflects level of care Parenthetical instructions under 99477 direct coders to use other codes for differing situations: • For the initiation of inpatient care of the normal newborn, report 99431 • For the initiation of care of the critically ill neonate, use 99395 • For initiation of inpatient hospital care of the neonate not requiring intensive observation, frequent interventions, and other intensive care Before the introduction of this code, most pediatricians used 99223 for babies requiring intensive care services, Molteni says. “They knew they were terribly underpaid for this work.” Others pushed the boundaries of coding convention and reported 99295, he adds. They were well paid, but auditors noted that these babies did not meet critical care criteria for 99295. (Note: Medicare unadjusted fees are $189 for 99223 and $950 for 99295, although private payer fees vary). MS. INSINGER is an editor at the Pediatric Coder’s Pink Sheet. Reprinted from the Pediatric Coder’s Pink Sheet, (c) 2008 Decision Health. For more information on the Pediatric Coder’s Pink Sheet, call 1-877-602-3835, or visit the Web site at www.decisionhealth.com/index2.aspx?prod_id=361&cat_it=4. 124 www.contemporarypediatrics.com Vol. 25, No. 9 http://www.decisionhealth.com/index2.aspx?prod_id=361&cat_it=4 http://www.contemporarypediatrics.com

Table of Contents Feed for the Digital Edition of Contemporary Pediatrics - September 2008

Contemporary Pediatrics - September 2008 Contents Editorial Your Voice Clinical Tip News Updates Eye on Washington Puzzler Dermatology: What’s your Dx? Behavior Cover Story: ECC Epidemic Parent Guides Discipline Techniques: The 12-Month-Old Exercise-induced Bronchospasm: Keeping Our Patients Active Food Safety Parent Guide CPR--Food Safety Malnutrition Links Surgeon General Links Hospice Links Childhood Cancer Links Rx for a Healthy Practice Rx for a Healthy Practice New Products Author Guidelines Journal Club Events Calendar Classifieds Index of Advertisers Postscript

Contemporary Pediatrics - September 2008

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