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cotrimble

Charley Posted Tue 02nd of October, 2018 12:04:18 PM
Our neonatal intensive care unit is spearheaded by neonatologists and nurse practitioners. The critical care neonatal codes allow only one 'physician' to bill per day. How does one determine if the nurse practitioner submits the per day charge or if the neonatologist submits the per day charge? Is the per day charge mutually exclusive with respect to the requirement that only one 'physician' can submit a charge each day. Of course, a nurse practitioner is not a physician but how and when does he/she bill for services?
SuperCoder Answered Wed 03rd of October, 2018 08:50:57 AM

Hi Charley,

The code range (99468- 99476) should only be billed by one provider and once per date of service - additional providers should bill critical care with 99291-99292. You can find this in the CPT book instructions under this code section: "These codes may be reported only by a single individual and only once per day, per patient, per hospital stay in a given facility." And later in the same section: "Critical care services provided by a second individual of a different specialty not reporting a per-day neonatal or pediatric critical care code can be reported with 99291, 99292."

Note: Critical care interfacility transport face-to-face (99466, 99467) or supervisory (99485, 99486) services may be reported by the same or different individual of the same specialty and same group, when neonatal or pediatric critical care services (99468-99476) are reported for the same patient on the same day. Also see the link below for further reference. Feel free to ask for any further query.

https://www.tnaap.org/programs/phiit/projects/2018-cpt-coding-updates.pdf 

 

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