Transferring a sick baby to another hospital

Question:

Our pediatric group practices in a community hospital, without an NICU. My pediatrician was called to attend a delivery of a newborn who was born premature and in respiratory distress. The baby needed to be stabilized and transferred to a level III neonatal intensive-care unit. The pediatrician spent 90 minutes from the time the baby was born, and she began the assessment and interventions, until the baby left for the NICU in another hospital. was. The baby was never admitted to our hospital, so I can’t bill the initial hospital service codes. What can we bill that reflects the work of our physician?

Answer:

Report critical care codes 99291, +99292 based on the time spent caring for the baby. In this case, bill 99291 and 99292 x1 unit.

The neonatologist who cares for the baby in the NICU will report neonatal critical care codes in the series 99468—99476 for care of the baby for a calendar day.

CPT^® says

“Also report 99291- 99292 for neonatal or pediatric critical care services provided by the individual providing critical care at one facility but transferring the patient to another facility. 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 codes 99291, 99292. ”[1]

• When attending to a newborn, use the newborn care codes for healthy neonates, 99460—99463. CPT^® uses the term normal newborn care.
• For a sick newborn, use initial and subsequent inpatient codes, 99221—99239. These require a diagnosis that that supports care of a sick baby.
• For intensive care—but not critical care—see codes 99477—99490. These codes are for caring for a newborn “who is not critically ill but requires intensive observation, frequent interventions, and other intensive care services.”[2]
• Critically ill neonates are billed with codes 99468—99476 by the neonatologist providing per day care. In the question above, the transferring physician uses critical care codes for the care provided before the transfer.

 

CPT^® made extensive changes to the newborn care section in 2009, and revised the editorial comments in 2013.  When caring for newborns, use the set of CPT^® codes that reflect the baby’s condition.

CodingIntel members can download the Newborn and Pediatrics Billing Guide for a detailed review of these services. And watch the Webinar Coding Inpatient Pediatric Services.

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[1] CPT^® 2020, Professional ed. 2019, AMA, Chicago p. 24

[2] CPT^® 2020, Professional ed. 2019, AMA, Chicago, p. 47

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