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John Posted 1 Year(s) ago
We are a free standing pediatric hospital that supports NICUs in other facilities, that utilizes nurse practitioners in an independent and split shared setting. We’ve done a lot of research on the scope of nurse practitioners in a split-shared setting and Medicare’s guideline clearly states that critical care code can’t be split shared. There aren’t any guidelines for intensive care codes, but we are inclined to treat the intensive codes (99477, 99478, 99479, and 99480) the same as the critical care codes and not split-share these services. Is there any documentation or guidance for this scenario?
SuperCoder Posted 1 Year(s) ago

Hi,

 

The guidelines related to your intensive care codes are given below, please read these guidelines as:

 

"Code 99477 represents the initial day of inpatient care for the child who is not critically ill but requires intensive observation, frequent interventions, and other intensive care services. Codes 99478-99480 are used to report the subsequent day services of directing the continuing intensive care of the low birth weight (LBW 1500-2500 grams) present body weight infant, very low birth weight (VLBW less than 1500 grams) present body weight infant, or normal (2501-5000 grams) present body weight newborn who does not meet the definition of critically ill but continues to require intensive observation, frequent interventions, and other intensive care services. These services are for infants and neonates who are not critically ill but continue to require intensive cardiac and respiratory monitoring, continuous and/or frequent vital sign monitoring, heat maintenance, enteral and/or parenteral nutritional adjustments, laboratory and oxygen monitoring, and constant observation by the health care team under direct supervision of the physician or other qualified health care professional. Codes 99477-99480 may be reported by a single individual and only once per day, per patient in a given facility. If readmitted to the intensive care unit during the same hospital stay, report 99478-99480 for the first day of intensive care and for each successive day that the child requires intensive care services.

 

These codes include the same procedures that are outlined in the Neonatal and Pediatric Critical Care Services section and these services should not be separately reported.

 

The initial day neonatal intensive care code (99477) can be used in addition to 99464 or 99465 as appropriate, when the physician or other qualified health care professional is present for the delivery (99464) or resuscitation (99465) is required. In this situation, report 99477 with modifier 25. Other procedures performed as a necessary part of the resuscitation (eg, endotracheal intubation [31500]) are also reported separately when performed as part of the pre-admission delivery room care. In order to report these procedures separately, they must be performed as a necessary component of the resuscitation and not simply as a convenience before admission to the neonatal intensive care unit.

 

The same procedures are included as bundled services with the neonatal intensive care codes as those listed for the neonatal (99468, 99469) and pediatric (99471-99476) critical care codes.

 

When the neonate or infant improves after the initial day and no longer requires intensive care services and is transferred to a lower level of care, the transferring individual does not report a per day intensive care service. Subsequent hospital care (99231-99233) or subsequent normal newborn care (99460, 99462) is reported as appropriate based upon the condition of the neonate or infant. If the transfer to a lower level of care occurs on the same day as initial intensive care services were provided by the transferring individual, 99477 may be reported.

 

When the neonate or infant is transferred after the initial day within the same facility to the care of another individual in a different group, both individuals report subsequent hospital care (99231-99233) services. The receiving individual reports subsequent hospital care (99231-99233) or subsequent normal newborn care (99462).

 

When the neonate or infant becomes critically ill on a day when initial or subsequent intensive care services (99477-99480) have been reported by one individual and is transferred to a critical care level of care provided by a different individual from a different group, the transferring individual reports either the time-based critical care services performed (99291, 99292) for the time spent providing critical care to the patient or the initial or subsequent intensive care (99477-99480) service, but not both. The receiving individual reports initial or subsequent inpatient neonatal or pediatric critical care (99468-99476) based upon the patient's age and whether this is the first or subsequent admission to critical care for the same hospital stay.

 

When the neonate or infant becomes critically ill on a day when initial or subsequent intensive care services (99477-99480) have been performed by the same individual or group, report only initial or subsequent inpatient neonatal or pediatric critical care (99468-99476) based upon the patient's age and whether this is the first or subsequent admission to critical care for the same hospital stay.

 

For the subsequent care of the sick neonate younger than 28 days of age but more than 5000 grams who does not require intensive or critical care services, use codes 99231-99233."

 

Please feel free to write if you have any concern or questions.

 

Thanks.

Posted by John, 1 Year(s). There are 2 posts. The latest reply is from SuperCoder.

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