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NICU charges

Shayna Posted Mon 23rd of January, 2012 14:32:39 PM

A baby was born on 12/13/2011 in hosp. sent to NICU (Same hosp) 12/16/2011 for thrombocytopenia, sepsis E coli and meningitis bacterial. The physician coded 99468, 1st day NICU. Is this correct and if not what code should I use.


SuperCoder Answered Mon 23rd of January, 2012 20:05:15 PM

1st day NICU: 12/16/2011: Initial Inpatient Neonatal Critical care, per day (28 days of age or younger): Justified and correct. Please let me know the reason for confusion.

Shayna Posted Mon 23rd of January, 2012 21:46:48 PM

I agree with code but our billing/keying personal feels like it should be 99469 because the infant was already in hopstial, but not in NICU. Do you have any documentaion to support besides what is in book?

Shayna Posted Mon 23rd of January, 2012 22:30:36 PM

Per CPT book, "Codes 99468 and 99469 are used to report services provided by a physician directing the inpatient care of a critically ill neonate or infant 28 days of age or younger. They represent care starting with the date of admission (99468) and subsequent days 99469 that the neonate remains in critical". I guess my confusion is in this case is the baby was born in hospital on 12/13/11, but not NICU. Baby did not transfer to NICU until 12/16/11, so do i code Initial Inpatient Neonatal Critical care, per day (28 days of age or younger): or subsequent days since since day 4 is what's in question. Sorry for all the questions, just want to code charges correctly.

SuperCoder Answered Tue 24th of January, 2012 18:49:56 PM

The concept is simple and clearcut. There should not be any confusion at all if the documentation is complete and clear.
NICU/PICU services when directing the care of a neonate/infant in a NICU/PICU. These codes represent care beginning with the date of admission to the NICU/PICU.
Ref: Page:B-19 of :
Based on above premise, before admission into NICU, the services are to be considered as Newborn Care Services.
So, here, NICU starts on DOS 12/16/2011, so E/M service for DOS 12/16/2011 to be coded as Initial Inpatient Neonatal Critical Care,per day, with cpt 99468. Subsequent NICU per day to be coded from the next day(from 12/17/2011) as 99469.

Shayna Posted Tue 24th of January, 2012 19:45:03 PM

Thank you!

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