Find-A-Code Focus Newsletter

Neo coding Q&A

January 24, 2019
Question: Hi I have a coding question hopefully you can help me with. Neonatologist was a birth of a very critical child, she billed 99468 and then it was decided to transfer the child to another facility, she also billed 99291 and 99292 x 3. Her time was denied, how should she have billed for the initial critical care and additional time spent with baby

Answer: Refer to the AMA Guidelines:

“When critical care services are provided to neonates or pediatric patients less than 6 years of age at two separate institutions by an individual from a different group on the same date of service, the individual from the referring institution should report their critical care services with the time-based critical care codes (99291, 99292) and the receiving institution should report the appropriate initial day of care code (99468, 99471, 99475) for the same date of service.”


“When the neonate or infant becomes critically ill on a day when initial or subsequent intensive care services (99477-99480), hospital services (99221-99233), or normal newborn services (99460, 99461, 99462) have been performed by one individual and is transferred to a critical care level of care provided by a different individual in a different group, the transferring individual reports either the time-based critical care services performed (9921, 99292) for the time spent providing critical care to the patient, the intensive care service (99477-99480), hospital care services (99221-99233), or normal newborn service (99460, 99461, 99462) performed, but only one service. The receiving individual reports initial or subsequent inpatient neonatal or pediatric critical care (99468-99476), as appropriate based upon the patient's age and whether this is the first or subsequent admission to the critical care unit for the hospital stay.”
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