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Pam Posted Tue 18th of September, 2012 16:03:55 PM

Neonatologist in NICU received a Critical Admit baby. Saw this baby off and on through out the day because Critical. Then at the end of the day determined the baby needed to be sent to another hospital for surgery. Can our Neonatologist go ahead and bill a Critical Admit global code 99468 since the baby spent most of the day at our facility and Neo did not keep track of the amount of time they spent on this baby? Or does our Neo have to use the 99291 and 99292 Critical care Total Duration Codes?

SuperCoder Answered Tue 18th of September, 2012 20:32:38 PM

The initial day of critical care for the evaluation and management of a critically ill neonate, 28-days of age or less, is reported with code 99468. Only one physician may report this code. If another physician provides critical care services to the neonate on the same date, that physician must report the services with critical care service codes 99291-99292.

Subsequent days of critical care to the critically ill neonate are reported per day with code 99469. As with the initial critical care, only one physician may report code 99469 on a given date.

Newborn Critical Care
When the newborn is critically ill or injured, codes exist for reporting of services provided during interfacility transport, initial critical care, and subsequent critical services. Reporting of codes for the services requires careful attention to CPT instructions and when more than one physician is caring for the infant, attention to which physician reports which codes.

Critical Care During Transport
Critical care services delivered by a physician, face-to-face, during an interfacility transport of critically ill or critically injured pediatric patient, 24-months of age or less, are reported based on the time of face-to-face care beginning when the physician assumes primary responsibility at the referring hospital/facility and ending when the receiving hospital/facility accepts responsibility for the patient's care. Report code 99466 for 30-74 minutes of hands-on care and code 99467 for each additional 30 minutes of hands-on care. Less than 30 minutes of hands-on care during transport would not be separately reported.

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