Codapedia  Forum - Questions & Answers

Q/A: Neonatologist was at the 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? 

A: According 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”

In addition, the AMA States;

“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.”

The AMA’s requirements if the infant becomes critically ill state the following;

“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 (99291, 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.”

For charges for the inpatient receiving provider for the initial or subsequent use the following as appropriate, based on age, admission and visit (99468-99476)