2008 Coding Questions and Answers
1. An infant is born at 29 wks gestation and has RDS. His birthweight is 1200 gms. He is
admitted to the NICU. It is evident that he has severe RDS and a decision is made to intubate
and give a surfactant.
The proper code(s):
a. 99295
b. 99295, 31520-25
c. 99295, 31520, 99946
Answer – A
99295 represents the initial neonatal critical care code for the evaluation and management of a
critically ill neonate 28 days or less. Critically ill neonates require cardiac and/or respiratory
support (including ventilator or nasal CPAP when indicated), continuous or frequent vital sign
monitoring, laboratory and blood gas interpretations, follow-up physician reevaluations, and
constant observation by the health care team under direct physician supervision. Immediate
preoperative evaluation and stabilization of neonates with life threatening surgical or cardiac
conditions are included under this code (CPT 2008, page 20-21; CPT Assistant Nov 05:10; CPT
Changes: An Insider’s View 2005; Coding for Pediatrics 2008, page 96-99)
Since the intubation and Surfactant was given in the NICU, these procedures are bundled
and can not be coded separately.
2. The above infant (An infant is born at 29 wks gestation and has RDS. His birthweight is 1200
gms. He is admitted to the NICU. It is evident that he has severe RDS and a decision is made
to intubate and give a surfactant.) is now in your NICU and is extubated at 24 hours of age and
placed on NCPAP. He continues to receive IV fluids and is started on trophic feedings.
The proper code for the 2nd day of life:
a. 99296
b. 99298
c. 99299
Answer – 99296
99296 represents a subsequent inpatient neonatal critical care, per day, for the evaluation and
management of a critically ill neonate 28 days or less. A critically ill neonate will require cardiac
and/or respiratory support (including ventilator or nasal CPAP when indicated), continuous or
frequent vital sign monitoring, laboratory and blood gas interpretations, follow-up physician reevaluations throughout a 24-hour period, and constant observation by the health care team under
direct physician supervision. (CPT 2009, page 21; CPT Assistant Nov 05:10; CPT Changes: An
Insider’s View 2005; Coding for Pediatrics 2008, page 96-99)
NCPAP can be considered a criteria for a critical baby if documentation supports the critical
nature of the illness. Remember that the expression “a high probably imminent or life
threatening deterioration of the patient’s condition” should be part of the physician’s note.
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3. On day 3 of life, the infant (An infant is born at 29 wks gestation and has RDS. His birthweight
is 1200 gms. He is admitted to the NICU. It is evident that he has severe RDS and a decision is
made to intubate and give a surfactant) is now in a hood receiving 30% oxygen. He continues
on IV fluids and advancing feeding. He is also started on caffeine for apnea.
The proper code is:
a. 99298
b. 99299
c. 99296
Answer – A
99298 represents a subsequent intensive care, per day, for the evaluation and management of the
recovering low birth weight infant (present body weight less than 1500 g). Infants with present boy
weight less than 1500 grams who are not critically ill but continue to require intensive cardiac and
respiratory monitoring, continuous and/or frequent vital sign monitoring, continuous and/or
frequent vital sign monitoring, heat maintenance, enteral and/or parenteral nutritional adjustments,
laboratory and oxygen monitoring, under direct physician supervision. This is a global code and all
procedures are included in the code and are not reported separately (CPT 2008, page 22; CPT
Assistant 11/05:10; CPT Changes: An Insider’s View 2003; Coding for Pediatrics 2008, page 100,
103, 104).
This infant satisfies all the criteria for a weight-based NICU intensive care code.
99298 (<1500 grams).
4. 34 week 1950 g preterm neonate born by vaginal delivery was hypotonic in delivery room.
The baby was admitted to the NICU for a Sepsis workup. The infant was not in oxygen, was
normotensive and a peripheral IV was started by the nurse. The baby was started on antibiotics.
Feedings started at the end of the day. The baby was on continual monitoring.
The proper code is:
a. 99295
b. 99223
c. 99477
Answer – C
99477 Initial hospital intensive care, per day, for the evaluation and management of the ill neonate,
28 days of age or less, who requires intensive observation and monitoring. Infants of any present
body weight 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 physician supervision. (CPT 2008, page 35, CPT Changes:
An Insiders View 2008, Coding for Pediatrics 2008, page 101-104).
This baby satisfies all of the criteria for an intensive not critical admission to the NICU.
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5. Same baby as above (34 week 1950 g preterm neonate born by vaginal delivery was hypotonic
in delivery room. The baby was admitted to the NICU for a Sepsis workup. The infant was not
in oxygen, was normotensive and a peripheral IV was started by the nurse. The baby was started
on antibiotics. Feedings started at the end of the day. The baby was on continual monitoring.)
The baby remained on antibiotics, DOL 2 – 6, feedings were improving but the baby was not
gaining weight adequately. In addition, the baby was mildly jaundiced with a total bilirubin
of 12 on day six.
The proper code for day of life 2-6:
a. 99233
b. 99299
c. 99232
Answer – B
99299 represents a subsequent intensive care, per day, for the evaluation and management of the
recovering low birth weight infant (present body weight of 1500-2500g). These infants are not
critically ill but continue to require intensive cardiac and respiratory monitoring, continuous and/or
frequent vital sign monitoring, continuous and/or frequent vital sign monitoring, heat maintenance,
enteral and/or parenteral nutritional adjustments, laboratory and oxygen monitoring, under direct
physician supervision. From the information given this baby does not appear to be critical and there
is not a “high probability” of imminent or life-threatening deterioration of the patient’s condition.
This patient is under constant observation by the healthcare team under direct physician
supervision. (CPT 2008, page 22; CPT Assistant 11/05:10. Coding for Pediatrics 2008, page 100104).
This baby satisfies the criteria for a weight-based code, 99299 (1501-2500 grams)
6. A 36 week (2300 gram) infant is transferred back to the referral hospital after 45 days stay in the
NICU. The child is on nasal cannula oxygen 0.75 lpm, NG/PO feeding and caffeine for apnea.
A large volume of records accompany the infant including chest x-rays. The admitting
neonatologist reviews all the records and then does a comprehensive physical exam and medical
decision making of moderate complexity. Total time spent on admitting this child was 2 hours.
The neonatologists in each hospital are in different groups.
The proper code(s) for the neonatologist in the referral hospital is:
a. 99223
b. 99477
c. 99222, 99356, 99357
Answer – A
99223 represents the first hospital inpatient encounter with the patient by the admitting physician. It
is an initial hospital care, per day, for the evaluation and management of a patient. The requirements
include documentation of a comprehensive history, a comprehensive examination, and medical
decision making of high complexity. Each component, history, physical examination and medical
decision making must reach the highest level of the E/M service code. (CPT 2008, page 13; CPT
Assistant Aug 04:11; Coding for Pediatrics 2008, page 94;
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99477 Initial hospital intensive care, per day, for the evaluation and management of the ill neonate,
28 days of age or less, who requires intensive observation and monitoring.
Infants of any present body weight 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 physician
supervision. . (CPT 2008, page 35, CPT Changes: An Insiders View 2008, Coding for Pediatrics
2008, page 101-104).
At first glance a 99477 code seems appropriate as the baby satisfies the criteria for an
intensive care admission. However, the infant is more than 28 days of age and the 99477 code
is restricted to babies 28 days or less. Therefore the 99223 code reflecting a high complexity
illness is chosen.
7. A 36 week (2300 gram) infant is transferred back to the referral hospital after 25 days stay in the
NICU. The child is on nasal cannula oxygen 0.75 lpm, NG/PO feeding and caffeine for apnea.
A large volume of records accompany the infant including chest x-rays. The admitting
neonatologist reviews all the records and then does a comprehensive physical exam and medical
decision making of moderate complexity. Total time spent on admitting this child was 2 hours.
The neonatologists in each hospital are in different groups.
The proper code(s) for the neonatologist in the referral hospital is:
a. 99223
b. 99477
c. 99222, 99356, 99357
Answer – B
99223 represents the first hospital inpatient encounter with the patient by the admitting physician. It
is an initial hospital care, per day, for the evaluation and management of a patient. The requirements
include documentation of a comprehensive history, a comprehensive examination, and medical
decision making of high complexity. Each component, history, physical examination and medical
decision making must reach the highest level of the E/M service code. (CPT 2008, page 13; CPT
Assistant Aug 04:11; Coding for Pediatrics 2008, page 94;
99477 Initial hospital intensive care, per day, for the evaluation and management of the ill neonate,
28 days of age or less, who requires intensive observation and monitoring. Infants of any present
body weight 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 physician supervision. . (CPT 2008, page 35, CPT Changes:
An Insiders View 2008, Coding for Pediatrics 2008, page 101-104).
This example reflects a intensive not critical baby of less than 28 days of age and therefore the
99477 code is correct.
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8. A 10 week old now 1600 grams, former 24 week infant requires laser surgery for ROP. The
baby is on nasal cannula oxygen .5lpm 30 %. The ophthalmologist requests that you provide
the sedation for the infant. You give the infant Ketamine and Versed and monitor the infant’s
vital signs during the 45 minute procedure. A repeat dose of Ketamine is needed. You continue
to monitor the infant for 15 minutes after the procedure is completed and document all of your
interactions in the medical record.
The proper codes are:
a. 99299, 99143, 99145 x 2
b. 99299, 99149, 99150 x 2
c. 99299, 99148, 99150 x 2
Answer – C
99299 represents a subsequent intensive care, per day, for the evaluation and management of the
recovering low birth weight infant (present body weight of 1500-2500g). These infants are not
critically ill but continue to require intensive cardiac and respiratory monitoring, continuous and/or
frequent vital sign monitoring, continuous and/or frequent vital sign monitoring, heat maintenance,
enteral and/or parenteral nutritional adjustments, laboratory and oxygen monitoring, under direct
physician supervision. From the information given this baby does not appear to be critical and there
is not a “high probability” of imminent or life-threatening deterioration of the patient’s condition.
This patient is under constant observation by the healthcare team under direct physician
supervision. (CPT 2008, page 22;CPT Assistant 11/05:10. Coding for Pediatrics 2008, page 100104).
99143 Moderate sedation services provided by the same physician performing the diagnostic or
therapeutic service that the sedation supports, requiring the presence of an independent trained
observer to assist in the monitoring of the patient’s level of consciousness and physiological status;
younger than 5 years of age. CPT 2008, page 435. Coding for Pediatrics 2008, page 121
99145 each additional 15 minutes intra-service time (list separately in addition to code
for primary service). Use code 99145 in conjunction with codes 99143 and 99144. CPT 2008, page
435. Coding for Pediatrics 2008, page 121
99148 Moderate sedeation services provided by a physician other than the health care professional
performing the diagnostic or therapeutic service that the sedation supports; younger than 5 years of
age, first 30 minutes intra-service time. CPT 2008, page 435. Coding for Pediatrics 2008, page 121.
99149 – age 5 years or older, first 30 minutes intra-service time. CPT 2008, page 435. Coding for
Pediatrics 2008, page 121
99150 each additional 15 minutes intra-service time (list separately in addition to code for primary
service.) Use code 99150 in conjunction with codes 99148 and 99149. CPT 2008, page 435
Coding for Pediatrics 2008, page 121
The 99299 code reflects an intensive care weight-based code of an infant 1501-2500 grams.
The 99148 moderate sedation code is used for the neonatologist is providing the sedation for
the ophthalmologist. This code is utilized for a child under 5 years of age and reflects the first
30 minutes of moderate sedation. 99159 is utilized for each additional 15 minutes in a patient
under 5 years of age.
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9. Baby girl Laurel is born at 33 weeks weighing 1550 grams and has mild respiratory distress.
Dr. Hardy evaluates the baby. The baby is requiring low flow nasal cannula at 30% oxygen.
She is placed on a cardiorespiratory monitor and continuous pulse oximetry, capillary blood
gases, chest x-ray, CBC and blood cultures are done. Antibiotics are started, as well as,
intravenous fluids. The first blood sugar is low and Dr. Hardy orders a bolus of IV dextrose to
be given. Dr. Hardy re-evaluates her four hours after admission and she has stabilized on 25%
oxygen after transiently needing 45%. Her blood sugar is also stabilized and Dr. Hardy orders
trophic feeds to be given.
The proper code for the 1st day is:
a. 99295
b. 99223
c. 99477
Answer - C
99477 Initial hospital intensive care, per day, for the evaluation and management of the ill neonate,
28 days of age or less, who requires intensive observation and monitoring. Infants of any present
body weight 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 physician supervision. (CPT 2008, page 35, CPT Changes:
An Insiders View 2008, Coding for Pediatrics 2008, page 101-104).
The baby does not satisfy the criteria of “critical” and therefore the intensive non-critical
code 99477 is utilized.
10. On the second day of life baby girl Laurel was weaned off oxygen but is having occasional
apnea episodes. Dr. Hardy orders caffeine to be started. The pulse oximeters and monitors
are continued. Parenteral nutrition is started and trophic feeds are continued. Her weight is
now 1495 grams. Blood cultures are negative but antibiotics are continued.
The proper code for the 2nd day is:
a. 99299
b. 99298
c. 99232
Answer - B
99298 represents a subsequent intensive care, per day, for the evaluation and management of the
recovering low birth weight infant (present body weight less than 1500 g). Infants with present boy
weight less than 1500 grams who are not critically ill but continue to require intensive cardiac and
respiratory monitoring, continuous and/or frequent vital sign monitoring, continuous and/or
frequent vital sign monitoring, heat maintenance, enteral and/or parenteral nutritional adjustments,
laboratory and oxygen monitoring, under direct physician supervision. This is a global code and all
procedures are included in the code and are not reported separately. (CPT 2008, page 22; CPT
Assistant 11/05:10; CPT Changes: An Insider’s View 2003; Coding for Pediatrics 2008, page 100,
103, 104).
This baby satisfies the criteria of a weight based intensive care code for an infant <1500 grams
(99298)
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11. A neonatologist is ask to consult on a 2100 gram infant with mild respiratory distress at
hospital A. He spends 40 minutes with the consult and speaks with the pediatrician. The
pediatrician remains the primary physician until 12 hours later when the baby deteriorates and
is intubated and is transferred to hospital B for a higher level of care. The neonatologists taking
care of the baby at Hospital A and Hospital B are in the same group.
The proper code(s) is:
a. 99477, 99295
b. 99252-25, 99295
c. 99291, 99295
Answer – B
99252 represents an inpatient consultation for a new or established patient, which requires these
three key components: an expanded problem focused history, an expanded problem focused
examination; and straightforward medical decision making. In general, an inpatient consultation
code is used only once by the reporting physician for an individual hospital patient for a particular
episode of care. Usually, the presenting problem(s) are of low severity. Physicians typically spend
40 minutes at the bedside and on the patient’s hospital floor or unit. Both the requesting and
consulting physician must document the request in the medical record. CPT 2008, page 16, CPT
Assistant Sep 02:11; CPT Changes: An Insider’s View 2007, Coding for Pediatrics 2008, page 86).
99295 represents the initial neonatal critical care code for the evaluation and management of a
critically ill neonate 28 days or less. Critically ill neonates require cardiac and/or respiratory
support (including ventilator or nasal CPAP when indicated), continuous or frequent vital sign
monitoring, laboratory and blood gas interpretations, follow-up physician reevaluations, and
constant observation by the health care team under direct physician supervision. Immediate
preoperative evaluation and stabilization of neonates with life threatening surgical or cardiac
conditions are included under this code. (CPT 2008, page 20-21; CPT Assistant Nov 05:10;
CPT Changes: An Insider’s View 2005; Coding for Pediatrics 2008, page 96, 97)
-25 modifier represents a significant, separately identifiable E/M service by the same physician
on the same day of the procedure or other service. The physician may need to
indicate that on the day that this procedure or service was performed, the patient’s condition
required a significant separately identifiable E/M service above and beyond the other service
or procedure provided. (CPT 2008 page 457; Coding for Pediatrics 2008 page 156, 157).
The reason that a consult code (99252) can be used initially is due to the fact that the
pediatrician remains the primary care physician, and the neonatololgist is the consultant.
All of the documentation rules must be included if the consultation code is utilized.
12. A neonatologist is ask to consult on a 2100 gram infant with mild respiratory distress at
hospital A. He spends 40 minutes with the consult and speaks with the pediatrician. The
pediatrician transfers care to the neonatologist. Twelve hours later the baby deteriorates and is
intubated and is transferred to hospital B for a higher level of care. The neonatologists taking
care of the baby at Hospital A and Hospital B are in the same group.
The proper code(s) is:
a. 99477, 99295
b. 99295
c. 99291, 99295
7
Answer – B
99295 represents the initial neonatal critical care code for the evaluation and management of a
critically ill neonate 28 days or less. Critically ill neonates require cardiac and/or respiratory
support (including ventilator or nasal CPAP when indicated), continuous or frequent vital sign
monitoring, laboratory and blood gas interpretations, follow-up physician reevaluations, and
constant observation by the health care team under direct physician supervision. Immediate
preoperative evaluation and stabilization of neonates with life threatening surgical or cardiac
conditions are included under this code. (CPT 2008, page 20-21; CPT Assistant Nov 05:10;
CPT Changes: An Insider’s View 2005; Coding for Pediatrics 2008, page 96, 97)
A consult code (99252) is not used in this example since the pediatrician transferred care to
the neonatologist. Although the intubation occurred at Hospital A it is bundled under the
global code 99295. Since the neonatologists taking care of the baby at Hospital A and Hospital
B are in the same group only one code can be placed.
13. A 2100 gram infant is admitted to hospital A for mild respiratory distress and the need for
40% hood oxygen and frequent vital signs. Twelve hours later the baby deteriorates, is
intubated and is transferred to hospital B for a higher level of care. The neonatologist taking
care of the baby at Hospital A and Hospital B are in different groups.
The proper code(s) is:
a. 99477, 99291 (for neo A), 99295(for neo B)
b. 99223, 99291, 31500-59 (for neo A), 99295 (for neo B)
c. 99291(for neo A), 99295 (for neo B)
Answer – A
99477 Initial hospital intensive care, per day, for the evaluation and management of the ill neonate,
28 days of age or less, who requires intensive observation and monitoring. Infants of any present
body weight 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 physician supervision. (CPT 2008, page 35, CPT Changes:
An Insiders View 2008, Coding for Pediatrics 2008, page 101-104).
99291 – Critical Care, evaluation and management of the critically ill or critically injured patient;
first 30-74 minutes. CPT 2008, page 20. CPT Assistant Dec 06:13.
99295 represents the initial neonatal critical care code for the evaluation and management of a
critically ill neonate 28 days or less. Critically ill neonates require cardiac and/or respiratory
support (including ventilator or nasal CPAP when indicated), continuous or frequent vital sign
monitoring, laboratory and blood gas interpretations, follow-up physician reevaluations, and
constant observation by the health care team under direct physician supervision. Immediate
preoperative evaluation and stabilization of neonates with life threatening surgical or cardiac
conditions are included under this code. (CPT 2008, page 20-21; CPT Assistant Nov 05:10;
CPT Changes: An Insider’s View 2005; Coding for Pediatrics 2008, page 96, 97)
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Neonatologist A admits this intensive non-critical baby to Hospital A and uses a 99477 code.
When the baby deteriorated and became critical the 99291 code (first 30-74 minutes is used).
Although intubation is not bundled under 99291 it is bundled under 99477 and therefore a
separate code for intubation (31500) was not used. Since the neonatologists are in different
groups and use separate identification numbers two separate codes can be used.
14. The baby in previous example (2100 gram infant who was critical for several days) is now
seven days of age and weighs 2130 grams. He is transferred back from hospital B to hospital A.
The neonatologist did not supervise or go on the transfer. The baby requires continuous
monitoring and there are frequent feeding adjustments. The physicians at hospital B and hospital
A are in the same group.
The proper code(s) is:
a. 99299
b. 99299, 99477
c. 99299, 99233
Answer – A
99299 represents a subsequent intensive care, per day, for the evaluation and management of the
recovering low birth weight infant (present body weight of 1500-2500g). These infants are not
critically ill but continue to require intensive cardiac and respiratory monitoring, continuous and/or
frequent vital sign monitoring, continuous and/or frequent vital sign monitoring, heat maintenance,
enteral and/or parenteral nutritional adjustments, laboratory and oxygen monitoring, under direct
physician supervision. From the information given this baby does not appear to be critical and there
is not a “high probability” of imminent or life-threatening deterioration of the patient’s condition.
This patient is under constant observation by the healthcare team under direct physician
supervision. (CPT 2008, page 22;CPT Assistant 11/05:10. Coding for Pediatrics 2008, page 100104).
Although this infant is transferred from Hospital B to Hospital A, a new admission code is not
used since the neonatologists are in the same group. Therefore a follow-up, intensive care
weight based code (99299) is used. If the neonatologist at Hospital B supervises or goes on the
transfer a 99288 code (supervision) and 99299 code (transport) can be added.
15. The baby in previous example (2100 gram infant who was critical for several days) is now
seven days of age and weighs 2130 grams. He is transferred back from hospital B to hospital A.
The neonatologist did not supervise or go on the transfer. The baby requires continuous
monitoring and there are frequent feeding adjustments. The physicians at hospital B and hospital
A are in different groups.
The proper code(s) is:
a. 99299
b. 99299, 99477
c. 99299, 99233
Answer – B
9
99299 represents a subsequent intensive care, per day, for the evaluation and management of the
recovering low birth weight infant (present body weight of 1500-2500g). These infants are not
critically ill but continue to require intensive cardiac and respiratory monitoring, continuous and/or
frequent vital sign monitoring, continuous and/or frequent vital sign monitoring, heat maintenance,
enteral and/or parenteral nutritional adjustments, laboratory and oxygen monitoring, under direct
physician supervision. From the information given this baby does not appear to be critical and there
is not a “high probability” of imminent or life-threatening deterioration of the patient’s condition.
This patient is under constant observation by the healthcare team under direct physician
supervision. (CPT 2008, page 22;CPT Assistant 11/05:10. Coding for Pediatrics 2008, page 100104).
99477 Initial hospital intensive care, per day, for the evaluation and management of the ill neonate,
28 days of age or less, who requires intensive observation and monitoring. Infants of any present
body weight 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 physician supervision. (CPT 2008, page 35, CPT Changes: An
Insiders View 2008, Coding for Pediatrics 2008, page 101-104).
This infant is transferred from Hospital B to Hospital A, and a new admission code can
be used since the neonatologists are in different groups. The 99299 code is used by the
neonatololgist at Hospital B, and the 99477 is used by the neonatologist at Hospital A. If the
neonatologist at Hospital B supervises or goes on the transfer a 99288 code (supervision) and
99299 code (transport) can be added.
16. A 2300 gram male infant is now four weeks of age and is getting ready for discharge.
The neonatologist asks for a multidisciplinary conference. The conference lasts for 40 minutes
and the parents are not present.
The proper code(s):
a. 99299, 99362
b. 99299, 99361
c. 99299, 99367-25
Answer - C
99299 represents a subsequent intensive care, per day, for the evaluation and management of the
recovering low birth weight infant (present body weight of 1500-2500g). These infants are not
critically ill but continue to require intensive cardiac and respiratory monitoring, continuous and/or
frequent vital sign monitoring, continuous and/or frequent vital sign monitoring, heat maintenance,
enteral and/or parenteral nutritional adjustments, laboratory and oxygen monitoring, under direct
physician supervision. From the information given this baby does not appear to be critical and there
is not a “high probability” of imminent or life-threatening deterioration of the patient’s condition.
This patient is under constant observation by the healthcare team under direct physician
supervision. (CPT 2008, page 22; CPT Assistant 11/05:10. Coding for Pediatrics 2008, page 100104).
10
99367 – Medical team conference with interdisciplinary team of health care professionals, patient
and/or family not present, 30 minutes or more; participation by physician. CPT 2008, page 30.
CPT Changes: An Insider’s View 2008. Coding for Pediatrics 2008, pages 72, 74.
-25 modifier represents a significant, separately identifiable E/M service by the same physician on
the same day of the procedure or other service. The physician may need to indicate that on the day
that this procedure or service was performed, the patient’s condition required a significant
separately identifiable E/M service above and beyond the other service or procedure provided.
(CPT 2008 page 457; Coding for Pediatrics 2008 page 156, 157).
The 99299 weight based intensive care code reflects the code for the day in question. The team
conference codes (99366-99368) are not bundled in the intensive care weight based code.
The team conference codes 99361 and 99362 are deleted in 2008. Three new team conference
codes 99366-99368 were established to differentiate the provider and to distinguish face-toface and non face-to-face team conference services.
Medical team conferences include face-to-face participation by a minimum of 3 qualified
health care professionals from different specialties or disciplines (each of whom provide direct
care to the patient), with or without the presence of the patient, family member(s),community
agencies, surrogate decision-maker(s) (eg, legal guardian), and/or caregiver(s). The
participants are actively involved in the development, revision, coordination and
implementation of health care services needed by the patient. These services may only be
reported when the physician or other qualified health care professional has performed faceto-face evaluations and/or treatments that are separate from any team conference within the
previous 60 days. Only one individual from the same specialty may report codes 99366-99368
for the same encounter. Reporting participants shall document their participation in the team
conference as well as their contributed information and subsequent treatment
recommendations. The team conference starts at the beginning of the review of an individual
patient and ends at the conclusion of the review. Time related to record keeping and report
generation is not reported. Regularly discharged planning rounds or conferences are not
reported with these codes. These conferences are specially planned to discuss the coordination
of care for children and families who are cared for in the NICU where a number of disciplines
must participate to develop a plan of care. The services should note be reported with t team
conference if part of a facility or organizational service that is provided under contract by an
organization or facility provider. When a physician provides face-to-face service at a team
conference with the parents present, a E/M code 99231-99233 is used.
Team conferences of less than 30 minutes are not reported. Medical record documentation
must support the participation of the physician or other qualified health care professional and
the time spent from the beginning of the review of an individual patient until the conclusion of
the review.
A -25 modifier should be appended to the code when it is reported on the same day as E/M
service to signify that a significant, separately identifiable service was provided.
Medical record documentation must include the date of the conference, time spent in
conference, attendees, and the issues discussed.
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17. A 2300 gram male infant is now four weeks of age and is getting ready for discharge. The
neonatologist asks for a multidisciplinary conference The conference lasts for 40 minutes and
the parents are present.
The proper code(s) is:
a. 99299, 99367
b. 99299, 99252
c. 99299, 99232-25
Answer – C
99299 represents a subsequent intensive care, per day, for the evaluation and management of the
recovering low birth weight infant (present body weight of 1500-2500g). These infants are not
critically ill but continue to require intensive cardiac and respiratory monitoring, continuous and/or
frequent vital sign monitoring, continuous and/or frequent vital sign monitoring, heat maintenance,
enteral and/or parenteral nutritional adjustments, laboratory and oxygen monitoring, under direct
physician supervision. From the information given this baby does not appear to be critical and there
is not a “high probability” of imminent or life-threatening deterioration of the patient’s condition.
This patient is under constant observation by the healthcare team under direct physician
supervision. (CPT 2008, page 22; CPT Assistant 11/05:10. Coding for Pediatrics 2008, page 100104).
99232 represents a subsequent hospital care, per day, for the evaluation and management of a
patient, which requires at least two of these three key components; an expanded problem focused
interval history; an expanded problem focused examination; medial decision making of moderate
complexity. (CPT 2008, page 13, CPT Assistant March 07, Coding for Pediatrics 2008, page 95).
-25 modifier represents a significant, separately identifiable E/M service by the same physician on
the same day of the procedure or other service. The physician may need to indicate that on the day
that this procedure or service was performed, the patient’s condition required a significant
separately identifiable E/M service above and beyond the other service or procedure provided.
(CPT 2008 page 457; Coding for Pediatrics 2008 page 156, 157).
The 99299 weight based intensive care code reflects the code for the day in question. The team
conference codes (99366-99368) are not bundled in the intensive care weight based code.
The team conference codes 99361 and 99362 are deleted in 2008. Three new team conference
codes 99366-99368 were established to differentiate the provider and to distinguish face-to-face
and non face-to-face team conference services.
Medical team conferences include face-to-face participation by a minimum of 3 qualified health
care professionals from different specialties or disciplines (each of whom provide direct care to the
patient), with or without the presence of the patient, family member(s), community agencies,
surrogate decision-maker(s) (eg, legal guardian), and/or caregiver(s). The participants are actively
involved in the development, revision, coordination and implementation of health care services
needed by the patient. These services may only be reported when the physician or other qualified
health care professional has performed face-to-face evaluations and/or treatments that are separate
from any team conference within the previous 60 days. Only one individual from the same
specialty may report codes 99366-99368 for the same encounter. Reporting participants shall
document their participation in the team conference as well as their contributed information and
12
subsequent treatment recommendations. The team conference starts at the beginning of the review
of an individual patient and ends at the conclusion of the review. Time related to record keeping
and report generation is not reported. Regularly discharged planning rounds or conferences
are not reported with these codes. These conferences are specially planned to discuss the
coordination of care for children and families who are cared for in the NICU where a number of
disciplines must participate to develop a plan of care. The services should not be reported with the
team conference if part of a facility or organizational service that is provided under contract by an
organization or facility provider. When a physician provides face-to-face service at a team
conference with the parents present, a E/M code 99231-99233 is used.
Team conferences of less than 30 minutes are not reported. Medical record documentation must
support the participation of the physician or other qualified health care professional and the time
spent from the beginning of the review of an individual patient until the conclusion of the review.
A -25 modifier should be appended to the code when it is reported on the same day as E/M service
to signify that a significant, separately identifiable service was provided. Medical record
documentation must include the date of the conference, time spent in conference, attendees,
and the issues discussed.
18. You are asked to attend a c-section of a 3600 gram infant. You arrive four minutes after
delivery, the one minute Apgar score is 8 and you briefly examine the infant, discuss newborn
care with the obstetrician and parents and document your presence. The baby is then sent to
the well baby nursery.
The proper code is:
a. 99440
b. 99436
c. no charge
Answer – B
99436 represents attendance at delivery and initial stabilization of newborn. Initial drying,
stimulation, suctioning, blow-by oxygen or CPAP without positive-pressure ventilation, a cursory
visual inspection of the neonate are included in the physician work associated with this code. A
verbal request or written order and the reason for the request from the delivering physician should
be documented in the attendance note. Use of this code should not be determined by a hospital
policy but requires a request from the delivering physician. (CPT 2008, page 34, CPT Assistant
Nov 05:15, Coding for Pediatrics 2008, page 90-91).
Although the physician arrives after the actual delivery the baby is examined and the
physician then orders the infant to be sent to the well baby nursery. The work provided
satisfies the criteria necessary for 99436 (a cursory visual inspection and discussion of care
of the newborn with the delivering physician and parents). It is important to remember that
medical record documentation must include the request for attendance at delivery and
substantiate the services performed. If there is no documentation by the delivering physician
in the maternal medical record, the verbal request and the reason for the request should be
documented attendance note. This code should not be reported without a specific request for
attendance. If hospital policy requires physician attendance at a specific type of delivery
(elective repeat cesarean section), attendance at delivery is not reported.
13
19. You are asked to attend a c-section of a 3600 gram infant. You arrive six minutes after
delivery, the Apgar scores are 8, 9. The baby has already been wrapped in a blanket and
you instruct the nurse to send the baby to the well baby nursery.
The proper code is:
a. 99440
b. 99436
c. no charge (code)
Answer – C
The physician arrives after the delivery and his/her physical presence is not necessary since the
infant has already been cared for by the nurse. The physician does not satisfy the criteria inherent in
the definition of 99436 (Initial drying, stimulation, suctioning, blow-by oxygen or CPAP without
positive-pressure ventilation, a cursory visual inspection of the neonate and discussion with the
obstetrician and parents). There is no code for the work provided by the physician.
20. You are called to an outlying hospital to see a baby in the well baby nursery who has
become clinically septic. You obtain blood cultures, perform a lumbar puncture and start
antibiotics. The infant is placed on hood oxygen (FIO2 60%). After evaluating the baby and
reviewing information, spending 50 minutes, you decide that baby needs to be transferred to
a higher level of care. There is no available bed at your hospital and the baby is transferred
to another group at an institution 30 minutes away. You are present during the transfer.
The proper code(s):
a. 99223, 62270-59, 99289
b. 99222, 99289
c. 99291, 66270-59, 99289
Answer: C
99291 – Critical Care, evaluation and management of the critically ill or critically injured patient;
first 30-74 minutes. CPT 2008, page 19-20. CPT Assistant Dec 06:13. Coding for Pediatrics 2008,
page 98-100.
62270 represents the code for a lumbar puncture (CPT 2008, page 268, CPT Assistant Nov 99:3233, Oct 03:2, Jul o6:4, CPT Changes: An Insider’s View 2000, 2002, Coding for Pediatrics 2008,
page 89, 158, 189).
-59 modifier is used to indicate that a procedure or service was distinct or independent from other
services performed on the same day. Only use this modifier if it best explains the circumstances
and no other, more descriptive, modifier is available. (CPT 2008, page 458; Coding for Pediatrics
2008, page 157, 163).
99289 Critical care services delivered by a physician, face-to-face, during an interfacility transport
of critically ill or critically injured pediatric parent, 24 months of age of less; first 30-74minutes of
hands on care during transport. (CPT 2008, Page 18; CPT Assistant May 05, Jul 06:4;CPT Changes:
An Insider’s View 2002, 2003. Coding for Pediatrics 2008, page 88, 90.
14
The above vignette describes a critical patient. Unlike the 99295, 99296, 99298, 99299, 99300,
99477 codes the code for the spinal tap (62270) is not bundled with the 99291 code.
Endotracheal intubation is also not bundled with 99291. The following services however are
bundled: the interpretation of cardiac output measurements (93561, 93562), chest CX rays
(71010, 71015, 71020), pulse oximetry (94760, 94761, 94762), blood gases, and information
data stored in computers (eg, “ECGs, blood pressures, hematologic data (99090); gastric
intubation (43752, 91105); temporary transcutaneous pacing (92953); ventilatory
management (94002-94004, 94660, 94662); and vascular access procedures (36000, 36410,
36415, 36591, 36600). Documentation of the critical nature of this patient must be provided.
21. Mrs. and Mrs. Arnaz come to see you because their first child, Ricky had gastroschisis.
Lucy is pregnant and she and Ricky are new to Los Angeles. They would like to know what the
capabilities are in your NICU if this baby has a similar problem. Their obstetrician, Dr. Mertz
has not indicated that there is a problem with this pregnancy. You spent 30 minutes with them.
The proper code:
a. 99404
b. 99402
c. 99252
Answer: B
99402 – Preventive medicine counseling and /or risk factor reduction interventions(s) provided to
an individual (separate procedure; approximately 30 minutes. CPT 2008, page 33, CPT Assistant
Aug 97:1, Jan 98, May 05:1. Coding for Pediatrics 2008, page 85-86.
Preventive medicine individual counseling codes (99401-99404) may be reported if the family
comes to the neonatologist either self-referred or sent by another provider to discuss a risk
reduction intervention (ie, seeking advice to avoid a further problem or complication. These
codes are reported based upon the time spent providing the counseling. Because they are
time-based codes, the medical record must include documentation of the total counseling time
and summary of the issues discussed. Another “coding approach” would be to not use the
consultation codes but to use the office visit codes (99201-99205), home service (99341-99345)
or domiciliary/rest home care codes (99324-99328).
22. Mrs. Abbott is admitted at 26 weeks with preterm labor. Her obstetrician, Dr. Costello, asks
you to see Mrs. Abbott for an inpatient consultation. You spend 45 minutes speaking with Mr.
and Mrs. Abbott about the risks of premature delivery and dictating the consult. Mrs. Abbott’s
labor abates and she is kept in the hospital on bed rest. She is treated with tocolytics and
steroids. At 30 weeks, she again begins to contract. Delivery seems imminent and inevitable.
Dr. Costello asks you to speak with Mr. and Mrs. Abbott again. You spend 30 minutes with
the family.
The proper code for the 1st consult is:
a. 99403
b. 99243
c. 99252
Answer: C
15
99252 represents an inpatient consultation for a new or established patient, which requires these
three key components: an expanded problem focused history, an expanded problem focused
examination; and straightforward medical decision making. In general, an inpatient consultation
code is used only once by the reporting physician for an individual hospital patient for a particular
episode of care. Usually, the presenting problem(s) are of low severity. Physicians typically spend
40 minutes at the bedside and on the patient’s hospital floor or unit. Both the requesting and
consulting physician must document the request in the medical record. CPT 2008, page 16, CPT
Assistant Sep 02:11; CPT Changes: An Insider’s View 2007, Coding for Pediatrics 2008, page 86).
The proper code for the 2nd consult is:
a. 99232
b. 99252
c. 99242
Answer: A
99232 represents a subsequent hospital care, per day, for the evaluation and management of a
patient, which requires at least two of these three key components; an expanded problem focused
interval history; an expanded problem focused examination; medial decision making of moderate
complexity. (CPT 2008, page 13, CPT Assistant March 07; Coding for Pediatrics 2008 page 95).
Only one consultation can be reported by a consultant per admission. Subsequent services
during the same admission are reported using subsequent hospital care codes 99231-99233
which include services to complete the initial consultation, monitor progress, revise
recommendations, or address a new problem. The selection of these codes is based upon
physician time spent during the consultation. Physicians typically spend 40 minutes at the
bedside and on the patient’s hospital floor or unit for a 99252 code and 25 minutes at the
bedside and/on the patient’s hospital floor or unit for a 99232 code. Other consultation codes
similar to this example utilizing time are as follows: 99251 (20 minutes); 99253 (55 minutes);
99254 (80 minutes); 99255 (110 minutes). Other subsequent follow-up codes for continual
services include: 99231 (15 minutes); 99233 (35 minutes).
23. Mr. and Mrs. Cramden are referred by their obstetrician for an outpatient consultation. Their
fetus, conceived on their honeymoon, was noted to have a unilateral dysplastic kidney and
complex congenital heart disease by their perinatologist, Dr. Norton. You spend 20 minutes
reviewing Alice’s records including the prenatal ultrasound and fetal echocardiogram. At the
time of the consultation, you spent 1 hour with the couple, since Ralph had many questions. It
took another 20 minutes to dictate and proof read your letter back to Dr. Norton.
The proper code for this consultation is:
a. 99358, 99244
b. 99245
c. 99233
Answer: A
99358 prolonged evaluation and management service before and/or after direct (face-to-face)
patient care (eg, review of extensive records and tests, communication with other professionals and
/or the patient/family); first hour (list separately I addition to code(s) for other physician service(s)
and/or inpatient or outpatient Evaluation and Management service) CPT 2008, page 29, CPT
Assistant Nov 05:10. Coding for Pediatrics 2008 pages 64-65, 96
16
99244 represents an office consultation for a new or established patient, which requires these 3 key
components: a comprehensive history; a comprehensive examination; and medical decision making
of moderate complexity. Usually the presenting problem(s) are of moderate to high severity.
Physicians typically spend 60 minutes face-to-face with the patient and/or family. CPT 2008, page
15, CPT Assistant April 07:11, Coding for Pediatrics 2008 pages 62, 209
The 99358 code can be used initially for record review and management services before and
after the face-to-face meeting. There is no RVU for 99358. The face-to-face part of this
consultation is only 60 minutes and therefore this is the code to be utilized. If the review
of the ultrasound and the records were done face-to-face with parents as well, 99245 (80
minutes) could be used.
24. Baby boy Keaton is born at a community hospital and your hospital is called to transport the
baby. You send the transport team which is composed of a nurse practitioner and a respiratory
therapist. You speak to the NNP several times and give her direction in terms of the
management. The baby is having respiratory distress and is intubated, given surfactant and
an umbilical artery catheter is placed. When the baby arrives at your hospital you admit this
intubated, critically ill baby. The NNP is employed by the hospital.
The proper code(s) are:
a. 99288, 99295
b. 99288, 31500, 94610, 36660, 99295
c. 99295
Answer: A
99288 represents physician direction of emergency medical systems (EMS, emergency care,
advance life support). The physician directs the performance of necessary medical procedures.
This physician directed transport team does not apply for in-house transport. The physician and
team remain in 2-way communication and decide together on the appropriate management and
intervention. The supervising physician cannot code the actual procedures and interventions
provided by the team unless he/she is physically present with the team during transport. Although
the 99288 code should be reported, there is no RVU or reimbursement for this code. (CPT 2008
page 18; CPT assistant, May 05:1; Coding for Pediatrics 2008, page 87-88.
99295 represents the initial neonatal critical care code for the evaluation and management of a
critically ill neonate 28 days or less. Critically ill neonates require cardiac and/or respiratory
support (including ventilator or nasal CPAP when indicated), continuous or frequent vital sign
monitoring, laboratory and blood gas interpretations, follow-up physician reevaluations, and
constant observation by the health care team under direct physician supervision. Immediate
preoperative evaluation and stabilization of neonates with life threatening surgical or cardiac
conditions are included under this code (CPT 2008, page 20-21; CPT Assistant Nov 05:10;
CPT Changes: An Insider’s View 2005; Coding for Pediatrics 2008, page 96-99)
In directed emergency care, the physician is in two-way voice communication with the rescue
personnel outside the hospital. The physician directs the performance of necessary medical
procedures. The physician and team remain in two-way communication and decide together
on the appropriate management and interventions for the child during transport. If this
communication is with the neonatal nurse practitioner (NNP) and the NNP is employed by the
hospital the neonatologist cannot report a code for that service. If the NNP is on the transport
17
team and is employed by the neonatal group, the NNP can report the transport codes if the
State of practice allows an independent billing number and the activities are covered in the
scope of practice. In addition, in some states, if the NNP is employed by the neonatal group
she is considered an “extension” of the neonatal group and the group’s provider number can
be used. Although the 99288 code should be reported, there is no RVU or reimbursement for
this code at this time.
25. Baby girl Allen is born at 28 weeks gestation at a level one center and Dr. Burns calls you
to come pick the baby up. You receive the call at 1:00 am. The transport team including the
neonatologist is ready to leave at 1:20 am and arrives at the referring hospital at 2:00 am. The
neonatologist spends 1.5 hours evaluating the baby. Included in this time are 10 minutes to
intubate and administer surfactant and 20 minutes to place umbilical venous and arterial
catheters. They leave the referring hospital at 3:30 am and arrive at the level 3 center at 4:15
am. The neonatologist admits the baby.
The proper code(s) are:
a. 99289, 99290 x2, 26510, 36660, 21500, 94610, 99295
b. 99289, 99290, 36510-59, 36660-59, 31500-59 94610-59, 99295
c. 99289, 99290 x2, 99295
Answer: B
99289 Critical care services delivered by a physician, face-to-face, during an interfacility transport
of critically ill or critically injured pediatric parent, 24 months of age of less; first 30-74minutes of
hands on care during transport. (CPT 2008, Page 18; CPT Assistant May 05, Jul 06:4;CPT Changes:
An Insider’s View 2002, 2003. Coding for Pediatrics, page 88
99290 each additional 30 minutes (List separately in addition to code for primary service)
CPT 2008, page 18. CPT Changes: An Insider’s View 2002 (Use 99290 in conjunction with 99289)
Coding for Pediatrics 2008, page 87-88.
36510- Catheterization of umbilical vein for diagnosis or therapy, newborn (CPT 2008, page 170;
CPT Assistant Jul 06:4; Coding for Pediatrics 2008, page 119, 218).
-59 modifier is used to indicate that a procedure or service was distinct or independent from other
services performed on the same day. Only use this modifier if it best explains the circumstances
and no other, more descriptive, modifier is available. (CPT 2008, page 458; Coding for Pediatrics
2008, page 157, 163).
36660 Catheterization, umbilical artery, newborn, for diagnosis or therapy. CPT 2008, page 174,
CPT Assistant Jul 06:4, CPT Changes: An Insider’s View 2008. Coding for Pediatrics 2008, pages
119, 218.
31500 is a procedure code for endotracheal intubation. (CPT 2008, page 135; CPT Assistant Jul
06:4; Coding for Pediatrics 2008, page 117).
94610 – Intrapulmonary surfactant administration by a physician through endotracheal tube (CPT
2008, page 413; CPT Changes: An Insider’s View 2007; Coding for Pediatrics 2008, page 88-89).
18
99295 represents the initial neonatal critical care code for the evaluation and management of a
critically ill neonate 28 days or less. Critically ill neonates require cardiac and/or respiratory
support (including ventilator or nasal CPAP when indicated), continuous or frequent vital sign
monitoring, laboratory and blood gas interpretations, follow-up physician reevaluations, and
constant observation by the health care team under direct physician supervision. Immediate
preoperative evaluation and stabilization of neonates with life threatening surgical or cardiac
conditions are included under this code (CPT 2008, page 20-21; CPT Assistant Nov 05:10;
CPT Changes: An Insider’s View 2005; Coding for Pediatrics 2008, page 96-99)
Codes 99289, 99290 report physical attendance and direct face-to-face care by a physician
during the interfacility transport of a critically ill patient <24 months of age. The infant’s
condition must meet the CPT definition for critical care. Services bundled under 99289 and
99290 are the same services that are bundled with the hourly critical care codes (99291,
99292). These defer from the bundled services that are part of the neonatal critical care
codes (99295, 99296). The code for umbilical vein catheterization (36510); umbilical artery
catheterization (36660); endotracheal intubation (31500) and Surfactant administration
(94610) are not bundled under the transport codes (99289, 99290). The total time spent with
the patient is 90 minutes in the beginning and then 45 minutes in transport for a total of 135
minutes. Subtracted from this is 30 minutes for the procedures. Therefore the total time is
105 minutes. 99289 is 30-74 minutes and 99290 adds an additional 30 minutes.
26. Baby girl Lewis is delivered at 27 weeks by c-section for maternal indications. Dr. Martin
attends the delivery, resuscitates the baby with PPV and as part of the resuscitation intubates
and gives surfactant in the delivery room. The baby is then transferred to the NICU where Dr.
Martin places an umbilical artery catheter and writes up a complete history and physical.
The proper codes are:
a. 99440, 31500-59, 94610-59, 99295
b. 99440, 31500, 94610, 99295, 36510
c. 99440, 99295
Answer: A
99440 represents an attendance at delivery with resuscitation including positive pressure ventilation
and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output.
(CPT 2008, page 34; CPT Assistant Apr 07:3; Coding for Pediatrics 2008,
page 90-91)
31500 is a procedure code for endotracheal intubation. If the intubation is performed in the delivery
room as an essential component of the resuscitation, it is reported separately. (CPT 2008, page
135; CPT Assistant Jul 06:4; Coding for Pediatrics 2008, page 117).
-59 modifier is used to indicate that a procedure or service was distinct or independent from other
services performed on the same day. Only use this modifier if it best explains the circumstances
and no other, more descriptive, modifier is available. (CPT 2008, page 458; Coding for Pediatrics
2008, page 157, 163).
19
94610 – Intrapulmonary surfactant administration by a physician through endotracheal tube. If the
procedure is done as part of the resuscitation it may be reported. If this procedure is done in the
NICU it is bundled under the global 99295 critical care code. There are very few instances where
Surfactant is necessary component of resuscitation in the delivery room. (CPT 2008, page 413;
CPT Changes: An Insider’s View 2007; Coding for Pediatrics 2008, page 88-89).
99295 represents the initial neonatal critical care code for the evaluation and management of a
critically ill neonate 28 days or less. Critically ill neonates require cardiac and/or respiratory
support (including ventilator or nasal CPAP when indicated), continuous or frequent vital sign
monitoring, laboratory and blood gas interpretations, follow-up physician reevaluations, and
constant observation by the health care team under direct physician supervision. Immediate
preoperative evaluation and stabilization of neonates with life threatening surgical or cardiac
conditions are included under this code (CPT 2008, page 20-21; CPT Assistant Nov 05:10;
CPT Changes: An Insider’s View 2005; Coding for Pediatrics 2008, page 96-99)
If the Surfactant administration (94610) is utilized as part of the resuscitative process it can
be coded separately. The physician must play an active role in this process. Observing the
respiratory therapist or NNP giving the surfactant does not satisfy criteria. There must be
hands-on participation in order to use this code.
27. Baby boy Stiller is born at term by the vaginal route. Dr. Meara is asked to attend the
delivery due to some late decelerations on the fetal monitor strip. Baby boy Stiller is breathing
spontaneously but the lungs sound wet. Dr. Meara applies a CPAP device to the baby for 2
minutes after which time the baby improves. The baby goes to the term nursery under another
physician’s care.
The proper code is:
a. 99440
b. 99431
c. 99436
Answer: C
99436 represents attendance at delivery and initial stabilization of newborn. Initial drying,
stimulation, suctioning, blow-by oxygen or CPAP without positive-pressure ventilation, a cursory
visual inspection of the neonate are included in the physician work associated with this code. A
verbal request or written order and the reason for the request from the delivering physician should
be documented in the attendance note. Use of this code should not be determined by a hospital
policy but requires a request from the delivering physician.
(CPT 2008, page 34, CPT Assistant Nov 05:15, Coding for Pediatrics 2008, page 90-91).
CPAP which is utilized to remove fluid from the lungs without positive pressure does not
constitute resuscitation and the need for 99440.
28. Baby boy Carson was born full term without any apparent health problems. Dr. Severinson
sees the baby in the morning and does routine newborn care. Four hours later Dr.
Severinson receives a call from nurse McMahon who tells him that baby boy Carson appears
cyanotic. Dr. Severinson tells her to begin oxygen therapy while he drives in from his
office. When he arrives, he finds that the baby has a loud holosystolic murmur and
20
decreased pulses in the lower extremities. He gets blood gases, chest x-ray, and blood
pressure measurements, CBC, and blood cultures. Antibiotics are given. The baby is
transferred to the NICU. Dr. Severinson calls the pediatric cardiologist who based on the
data she is given, tells Dr. Severinson to start prostaglandin until she can get there to
perform the echocardiogram.
The proper code(s) are:
a. 99295
b. 99431-25, 99295
c. 99431, 99296
Answer: B
99431 represents the history and examination of the normal newborn infant, initiation of diagnostic
and treatment programs and preparation of hospital records. (CPT 2008, page 33; CPT Assistant
May 05:1 Coding for Pediatrics 2008, page 92-93
-25 modifier represents a significant, separately identifiable E/M service by the same physician on
the same day of the procedure or other service. The physician may need to indicate that on the day
that this procedure or service was performed, the patient’s condition required a significant
separately identifiable E/M service above and beyond the other service or procedure provided.
(CPT 2008 page 457; Coding for Pediatrics 2008 page 156, 157).
99295 represents the initial neonatal critical care code for the evaluation and management of a
critically ill neonate 28 days or less. Critically ill neonates require cardiac and/or respiratory
support (including ventilator or nasal CPAP when indicated), continuous or frequent vital sign
monitoring, laboratory and blood gas interpretations, follow-up physician reevaluations, and
constant observation by the health care team under direct physician supervision. Immediate
preoperative evaluation and stabilization of neonates with life threatening surgical or cardiac
conditions are included under this code (CPT 2008, page 20-21; CPT Assistant Nov 05:10;
CPT Changes: An Insider’s View 2005; Coding for Pediatrics 2008, page 96-99)
The 99431 code can be used initially for the baby was considered a normal newborn.
Later on when there was change in status, the neonatologist evaluated, stabilized and
started medication for cardiac disease. The code 99295 states that “preoperative evaluation
and stabilization of neonates with life threatening surgical or cardiac conditions are included
under this code”.
29. Baby Tooley is a 930 gm 27 wk infant on day 8. He was on 1.5 Liters High Flow nasal
canula simulating CPAP but despite caffeine was having multiple apnea and bradycardia events
requiring bag and mask stimulation. He was placed on CPAP at 5 cm and room air. The apnea
and bradycardia events improved. He is on trophic feedings day 4/5 of 10ml/kg/ day of breast
milk and TPN via a central PICC line.
The proper code is:
a. 99296
b. 99298
c. 99292
Answer: A
21
99296 represents a subsequent inpatient neonatal critical care, per day, for the evaluation and
management of a critically ill neonate 28 days or less. A critically ill neonate will require cardiac
and/or respiratory support (including ventilator or nasal CPAP when indicated), continuous or
frequent vital sign monitoring, laboratory and blood gas interpretations, follow-up physician reevaluations throughout a 24-hour period, and constant observation by the health care team under
direct physician supervision. (CPT 2008, page 21; CPT Assistant Nov 05:10; CPT Changes:
An Insider’s View 2005; Coding for Pediatrics 2008, page 96- 99)
This baby can be considered critical if the high flow nasal canula which simulates nasal CPAP
represents a therapy which if removed would lead to “a high probability imminent or lifethreatening deterioration of the patient’s condition”. There is no definition for the timeframe
of imminent or life-threatening deterioration. The physician must use his or her judgment in
assigning this definition. To demonstrate the appropriate application of a critical care code
the physician must clearly document in the medical record the child’s condition and
instability along with the risks to the patient and the frequency of needed assessment and
interventions.
30. Baby Gregory is a 3.2 Kg. infant 35 day old infant now corrected to 37 weeks gestational
age post gastroschisis repair being drip fed an elemental formula. He developed signs of sepsis,
necrotizing enterocolitis and DIC. He is intubated, placed on High Frequency (HFOV)
ventilation prior to exploratory laparotomy.
The proper code is:
a. 99294
b. 99296
c. 99292
Answer: A
99294 represents a subsequent inpatient pediatric critical care, per day, for the evaluation and
management of a critically ill infant or young child, 29 days through 24 months of age. This code
is bundled and procedures may not be reported separately. CPT 2008 page 21, CPT Assistant Nov
05:10; CPT Changes: An Insider’s View 2005; Coding for Pediatrics 2008 96-99.
As baby is >28 days, and this is critical care 99294 is the correct code.
31. Baby Smith is a 2 day old 435 gram 23 week premature infant on HFOV and 80% oxygen.
The proper code for day is:
a. 99296
b. 99298
c. 99292
Answer: A
99296 represents a subsequent inpatient neonatal critical care, per day, for the evaluation and
management of a critically ill neonate 28 days or less. A critically ill neonate will require cardiac
and/or respiratory support (including ventilator or nasal CPAP when indicated), continuous or
frequent vital sign monitoring, laboratory and blood gas interpretations, follow-up physician reevaluations throughout a 24-hour period, and constant observation by the health care team under
direct physician supervision. (CPT 2009, page 21; CPT Assistant Nov 05:10; CPT Changes: An
Insider’s View 2005; Coding for Pediatrics 2008, page 96-99)
22
This baby is only two days old and satisfies the criteria for subsequent day critical care.
32. Baby Apgar is a 90 day old former 24 wk premature who weighs 2.1 Kg and who remains
on caffeine for apnea and diuretics and pulmicort and and oxygen at 100mL flow. He is being
discharged to his parents on a home monitor, oxygen and the above medications. Time spent 40
minutes.
The proper code for the discharge day is:
a. 99299
b. 99238
c. 99239
Answer: C
99239 represents a code which reports total duration of time spent by a physician for final hospital
discharge of a patient. The code includes a final examination, discussion of the hospital stay (the
time does not have to be continuous), instructions for continuing care to all relevant caregivers and
preparation of discharge records, prescriptions and referral forms. This code represents hospital
discharge day management; 30 minutes or more. (CPT 2008 page 14, CPT Assistant Sept 06:8;
Coding for Pediatrics 2008, page 58-59).
Documentation remains most important and there must be a place in the discharge note
for detailing the discussion with the parents. Years later if a malpractice action is filed,
the documentation will serve to assist the neonatologist if he/she is cited for not speaking
in detail to the parents
33. Baby Harvey is a former 36 week 14 day old late preterm infant who weighs 2. 8 Kg being
discharged today to parents breast feeding every two to three hours. He is to follow up in two
days with his primary care physician. Time spent 23 minutes.
The proper code for discharge is?
a. 99238
b. 99239
c. 99300
Answer: A
99238 Hospital discharge day management; 30 minutes or less reported by attending physician
providing discharge services on a date other than the day of admission. The reporting is based on
the total time (time does not have to be continuous) spent performing all final discharge records.
These codes may be used to report discharge services provided to patients who die during their
hospital stay. CPT 2008 page 14, CPT Assistant Sep 06:8, Coding for Pediatrics 2008 pages 58-59.
34. You are called to the c-section delivery of a 28 week infant. His Apgars are 6 and 7, and he
has an adequate respiratory drive and a normal cry for his gestational age. His weight is 800
grams. He requires intubation for respiratory distress and is given a prophylactic dose of
surfactant by the nurse and RT, then extubated and placed on CPAP. He has an O2
saturation of 92%, but his perfusion is poor. You place an Umbilical venous line, administer
8 ml of normal saline, then transport the infant to the NICU where he is continued on CPAP.
23
The proper codes are:
a. 99440, 36510-59. 99295
b. 99436, 31500-59, 94610-59, 36510-59
c. 99440, 99295
Answer: A
99440 represents attendance at delivery with resuscitation including positive pressure ventilation
and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output.
(CPT 2008, page 34; CPT Assistant Apr 07:3; Coding for Pediatrics 2008, pages 90-91)
36510- Catheterization of umbilical vein for diagnosis or therapy, newborn (CPT 2008, page 170;
CPT Assistant Jul 06:4; Coding for Pediatrics 2008, page 119, 218).
94610 – Intrapulmonary surfactant administration by a physician through endotracheal tube. If the
procedure is done as part of the resuscitation it may be reported. If this procedure is done in the
NICU it is bundled under the global 99295 critical care code. There are very few instances where
Surfactant is necessary component of resuscitation in the delivery room. (CPT 2008, page 413;
CPT Changes: An Insider’s View 2007; Coding for Pediatrics 2008, page 88-89).
31500 is a procedure code for endotracheal intubation. If the intubation is performed in the delivery
room as an essential component of the resuscitation, it is reported separately. (CPT 2008, page
135; CPT Assistant Aug 06:4; Coding for Pediatrics 2008, page 117
-59 modifier is used to indicate that a procedure or service was distinct or independent from other
services performed on the same day. Only use this modifier if it best explains the circumstances
and no other, more descriptive, modifier is available. (CPT 2008, page 458; Coding for Pediatrics
2008, page 157, 163).
99295 represents the initial neonatal critical care code for the evaluation and management of a
critically ill neonate 28 days or less. Critically ill neonates require cardiac and/or respiratory
support (including ventilator or nasal CPAP when indicated), continuous or frequent vital sign
monitoring, laboratory and blood gas interpretations, follow-up physician reevaluations, and
constant observation by the health care team under direct physician supervision. Immediate
preoperative evaluation and stabilization of neonates with life threatening surgical or cardiac
conditions are included under this code (CPT 2008, page 20-21; CPT Assistant Nov 05:10;
CPT Changes: An Insider’s View 2005; Coding for Pediatrics 2008, page 96-99)
In the example represented above, the Surfactant was utilized prophylactically and was not an
integral part of the resuscitative process. Therefore the code for endotracheal intubation
(31500), and the code for surfactant administration (94610) is not utilized.
35. You are asked by a pediatrician to examine a newborn infant in the regular nursery
with several minor dysmorphic features and recommend whether a karotype analysis is
indicated. You perform a complete physical exam and determine that while a chromosomal
anomaly is not likely, karyotype is indicated. You discuss your findings with the infant’s
parents and relay your opinion to the pediatrician by telephone. Time spent 45 minutes.
24
The proper code is:
a. 99201
b. 99252
c. 99241
Answer: B
99252 represents an inpatient consultation for a new or established patient, which requires these
three key components: an expanded problem focused history, an expanded problem focused
examination; and straightforward medical decision making. In general, an inpatient consultation
code is used only once by the reporting physician for an individual hospital patient for a particular
episode of care. Usually, the presenting problem(s) are of low severity. Physicians typically spend
40 minutes at the bedside and on the patient’s hospital floor or unit. Both the requesting and
consulting physician must document the request in the medical record. CPT 2008, page 16, CPT
Assistant Sep 02:11; CPT Changes: An Insider’s View 2007, Coding for Pediatrics 2008, page 86).
These consultation codes are time based. Code 99251 is used if 20-40 minutes is spent in
consultation. 99252 represents 40-55 minutes; 99253 from 55-80 minutes; 99254 from 80
minutes to 110 minutes. Documentation is extremely important when utilizing any of these
consultation codes.
36. You are caring for an 1854gram infant, now 10 days old. He initially had severe RDS, requiring
mechanical ventilation, but has since been weaned first to NCPAP and now to 3 lpm high flow
nasal cannula oxygen (35%) to simulate CPAP. He remains tachypneic but has normal arterial
blood gases. He is receiving parenteral nutrition as well as enteral feedings at 80 ml/kg/day.
The proper code is:
a. 99233
b. 99296
c. 99299
Answer: B
99296 represents a subsequent inpatient neonatal critical care, per day, for the evaluation and
management of a critically ill neonate 28 days or less. A critically ill neonate will require cardiac
and/or respiratory support (including ventilator or nasal CPAP when indicated), continuous or
frequent vital sign monitoring, laboratory and blood gas interpretations, follow-up physician reevaluations throughout a 24-hour period, and constant observation by the health care team under
direct physician supervision. (CPT 2009, page 21; CPT Assistant Nov 05:10; CPT Changes: An
Insider’s View 2005; Coding for Pediatrics 2008, page 96-99)
In the example above the question remains that if high flow nasal cannula is used to simulate
NCPAP, does this alone satisfy the criteria for being critical? In order for this to be true the
patient must satisfy CPT definitions where a critical illness impairs one or more vital organs a
high probability of imminent or life-threatening deterioration of the patient’s condition if the
therapy is withdrawn. The documentation provided must satisfy this criteria.
25
37. You have been asked by an obstetrician to counsel a family that has just been informed their 30
week fetus has an apparent bowel obstruction on fetal ultrasound. You meet with the family for
30 minutes in your office and discuss the differential diagnosis of in utero bowel obstruction,
including possible genetic causes. You spend an additional 15 minutes drafting a consult letter
to the obstetrician.
The proper code is:
a. 99404
b. 99245
c. 99242
Answer -C
99242 represents an office consultation for a new or established patient, which requires these 3 key
components: an expanded problem focused history; an expanded problem focused examination; and
straightforward medical decision making. Usually the presenting problem(s) are of low severity. .
Physicians typically spend 30 minutes face-to-face with the patient and/or family. CPT 2008, page
5, 15, CPT Assistant Apr 07:11 Coding for Pediatrics 2008 pages 62, 209
It is important to remember that time spent in the office/out patient can only utilize face-toface time. Post service time (a report) cannot be added when selecting the typical time used
with this code. This differs from the unit/floor time service which incorporates non face-toface pre and post time. Physicians typically spend 30 minutes face-to-face with the family in
a 99242 scenario. The additional 15 minutes can not be added since this was not face-to-face.
38. A 2400 g infant is transferred to you from the normal newborn nursery for persistent tachypnea
and retractions. You perform a complete history, physical exam, and laboratory workup,
including a percutaneous arterial blood gas and lumbar puncture. You admit him to the NICU,
begin antibiotics and the baby is placed on 3 lpm nasal cannula(60% oxygen) in order to
simulate NCPAP.
The proper code is:
a. 99223
b. 99295
c. 99477
Answer – B
99295 represents the initial neonatal critical care code for the evaluation and management of a
critically ill neonate 28 days or less. Critically ill neonates require cardiac and/or respiratory
support (including ventilator or nasal CPAP when indicated), continuous or frequent vital sign
monitoring, laboratory and blood gas interpretations, follow-up physician reevaluations, and
constant observation by the health care team under direct physician supervision. Immediate
preoperative evaluation and stabilization of neonates with life threatening surgical or cardiac
conditions are included under this code (CPT 2008, page 20-21; CPT Assistant Nov 05:10;
CPT Changes: An Insider’s View 2005; Coding for Pediatrics 2008, page 96-99)
26
NCPAP is a criteria for a critical care code only if there is documentation of the critical
nature of the illness. Remember that the expression “a high probably imminent or life
threatening deterioration of the patient’s condition” should be part of the physician’s note.
39. A 14 day old infant now weighs 900 grams. She continues to require nasal cannula oxygen 0.5
lpm, and is receiving caffeine for occasional apnea. She is on 60 ml/kg/day of enteral feeds and
60 ml/kg/day intravenous alimentation.
The proper code is:
a. 99231
b. 99296
c. 99298
Answer – C
99298 represents a subsequent intensive care, per day, for the evaluation and management of the
recovering low birth weight infant (present body weight less than 1500 g). Infants with present boy
weight less than 1500 grams who are not critically ill but continue to require intensive cardiac and
respiratory monitoring, continuous and/or frequent vital sign monitoring, continuous and/or
frequent vital sign monitoring, heat maintenance, enteral and/or parenteral nutritional adjustments,
laboratory and oxygen monitoring, under direct physician supervision. This is a global code and all
procedures are included in the code and are not reported separately (CPT 2008, page 22; CPT
Assistant 11/05:10; CPT Changes: An Insider’s View 2003; Coding for Pediatrics 2008, page 100,
103, 104).
This is a weight-base intensive care code 99298 (<1500 grams) and the intravenous
alimentation is bundled as part of the code.
40. Term infant with good prenatal care was delivered by normal spontaneous vaginal delivery and
sent to NBN where it was noticed in visual inspection by the nurses to have an imperforate anus.
Neonatologist was called and baby was then transferred to NICU, made NPO and awaiting
surgical consultation. Surgery was performed later that day.
The proper codes are:
a. 99295
b. 99431, 99477
c. 99223
Answer – A
99295 represents the initial neonatal critical care code for the evaluation and management of a
critically ill neonate 28 days or less. Critically ill neonates require cardiac and/or respiratory
support (including ventilator or nasal CPAP when indicated), continuous or frequent vital sign
monitoring, laboratory and blood gas interpretations, follow-up physician reevaluations, and
constant observation by the health care team under direct physician supervision. Immediate
preoperative evaluation and stabilization of neonates with life threatening surgical or cardiac
conditions are included under this code (CPT 2008, page 20-21; CPT Assistant Nov 05:10;
CPT Changes: An Insider’s View 2005; Coding for Pediatrics 2008, page 96-99)
27
CPT 2008 in their description of 99295 states “immediate preoperative evaluation and
stabilization of neonates with life threatening surgical or cardiac conditions are included
under this code” the question remains is an imperforate anus a life threatening surgical
condition. The coding committee believes that if surgery is performed on the same day that
this baby satisfies the criteria for a critical care code. If surgery was done the following day
then 99477 is the correct code. 99431 (normal newborn care) should not be included in the
answer since the baby was not seen by the neonatologist in the newborn nursery as a “normal
newborn.”
41. Term infant in the newborn nursery was noticed by the pediatrician to have a dislocation of
the hip and was concerned about mild dysplasia to frank dislocation. She consults with the
neonatologist and requests that the neonatologist verify the hip instability by examination. The
neonatologist agrees with the pediatrician’s assessment, and provides a detailed history, detailed
physical examination and low complexity decision making. The pediatrician requests that the
neonatologist assume care. Infant remains in the newborn nursery.
The proper code is:
a. 99477
b. 99254
c. 99253
Answer - C
99253 represents an inpatient consultation for a new or established patient, which requires these
three key components: a detailed history, a detailed examination; and medical decision making
of low complexity. In general, an inpatient consultation code is used only once by the reporting
physician for an individual hospital patient for a particular episode of care. Usually, the presenting
problem(s) are of moderate severity. Physicians typically spend 55 minutes at the bedside and on
the patient’s hospital floor or unit. Under the revised CMS consultation standards, both the
requesting and the consulting physician (or other provider) must document the request in the
medical record. (CPT 2008, page 16, CPT Assistant Sep 02:11; CPT Changes: An Insider’s View
2007, Coding for Pediatrics 2008, page 67-68).
Note that the 99253 code requires the components of a detailed history, a detailed examination
and decision making of low complexity. In the example above these statements provide
enough information to utilize the 99253 code. If the history and physical examination was
comprehensive and the decision making was at moderate complexity then 99254 would be the
correct code. For the criteria necessary for these codes see Coding for Pediatrics 2008 page 62.
42. A term infant is delivered to a mother with no prenatal care, unknown GBS status, and maternal
fever 100.6. The mother receives one dose of antibiotics six hours before delivery. The infant
is taken to the newborn nursery and is admitted by the neonatologist. A CBC and blood culture
are taken by the nurse. There are no other signs or symptoms and infant begins feeding.
The proper code is:
a. 99477
b. 99431
c. 99223
Answer – B
28
99431 represents the history and examination of the normal newborn infant, initiation of diagnostic
and treatment programs and preparation of hospital records.. (CPT 2008, page 33; CPT Assistant
May 05:1, Coding for Pediatrics 2008, page 92, 93).
This is a common scenario where the baby appears normal but the history necessitates a
further evaluation. Since there are no clinical signs which would place this baby as “not
normal”, a 99431 is appropriate.
43. The Neonatologist is called to see a mother in labor in the ED; a consultation is done but the
patient is not admitted. Neo spends 30 minutes face to face.
The proper code:
a. 99402
b. 99242
c. 99251
Answer – B
99242 represents an office consultation for a new or established patient, which requires these 3 key
components: an expanded problem focused history; an expanded problem focused examination; and
straightforward medical decision making. Usually the presenting problem(s) are of low severity.
Physicians typically spend 30 minutes face-to-face with the patient and/or family. CPT 2008, page
5, 15, CPT Assistant Apr 07:11 Coding for Pediatrics 2008 pages 62, 209
The ED department represents an outpatient consultation. In this case the mother is never
admitted to the hospital. The 99402 code is a perinatal counseling and consultation code with
no defined symptom or established illness. The 99251 code is an inpatient consultation.
Therefore the 99242 code is used since 30 minutes of face-to-face time was utilized.
44. The neonatologist attempts to place a PICC line in a 1800 gram infant, but is unsuccessful.
The proper codes are:
a. 99299, 36555-59
b. 99299
c. 99233, 36555-59
Answer – B
99299 represents a subsequent intensive care, per day, for the evaluation and management of the
recovering low birth weight infant (present body weight of 1500-2500g). These infants are not
critically ill but continue to require intensive cardiac and respiratory monitoring, continuous and/or
frequent vital sign monitoring, continuous and/or frequent vital sign monitoring, heat maintenance,
enteral and/or parenteral nutritional adjustments, laboratory and oxygen monitoring, under direct
physician supervision. From the information given this baby does not appear to be critical and there
is not a “high probability” of imminent or life-threatening deterioration of the patient’s condition.
This patient is under constant observation by the healthcare team under direct physician
supervision. (CPT 2008, page 22; CPT Assistant 11/05:10. Coding for Pediatrics 2008, page 100104).
29
36555 Insertion of non-tunneled centrally inserted central venous catheter, younger than 5 years of
age. To qualify as a central venous access catheter or device, the tip of the catheter/device must
terminate in the subclavian, brachiocephalic (innominate) or iliac veins, the superior or inferior vena
cava, or the right atrium. The venous access device may be either centrally inserted (jugular,
subclavian, femoral vein or inferior vena cava catheter entry site) or peripherally inserted (eg,
basilica or cephalic vein). The device may be accessed for use either via exposed catheter (external
to the skin), via a subcutaneous port or via a subcutaneous pump. CPT 2008, pages 170, 171.CPT
Assistant Dec 04:7, Jul 06:4, CPT Changes: An Insider’s View 2004. Coding for Pediatrics 2008,
page 89, 119.
In this example the 36555 code is not utilized for this procedure (insertion of a PICC line) is
bundled under 99299. For a complete description of bundled verses not bundled services in
both critical care and intensive care situations see Coding for Pediatrics 2008 page 89.
45. Baby Doe is born at 26 weeks gestation. The Neonatologist attends the delivery. The child is
born depressed with gasping respirations and the infant is intubated by the neonatologist. The
infant does not respond well to hand ventilation. A decision to give intra-tracheal surfactant
down the ET tube is made and the surfactant is delivered. The infant pinks up shortly after this,
heart rate improves, and the child becomes easier to ventilate. The infant is moved to the NICU
and admitted.
The proper codes are:
a. 99436, 31500-59, 99295
b. 99440, 31500-59, 94610-59, 99295
c. 99431, 99436, 31500, 99295
Answer - B
99440 represents an attendance at delivery with resuscitation including positive pressure ventilation
and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output.
(CPT 2008, page 34; CPT Assistant Apr 07:3; Coding for Pediatrics 2008, pages 90-91)
31500 is a procedure code for endotracheal intubation. If the intubation is performed in the delivery
room as an essential component of the resuscitation, it is reported separately. (CPT 2008, page
135; CPT Assistant Aug 06:4; Coding for Pediatrics 2008, page 117).
-59 modifier is used to indicate that a procedure or service was distinct or independent from other
services performed on the same day. Only use this modifier if it best explains the circumstances
and no other, more descriptive, modifier is available. (CPT 2008, page 458; Coding for Pediatrics
2008, page 157, 163).
94610 – Intrapulmonary surfactant administration by a physician through endotracheal tube. If the
procedure is done as part of the resuscitation it may be reported. If this procedure is done in the
NICU it is bundled under the global 99295 critical care code. There are very few instances where
Surfactant is necessary component of resuscitation in the delivery room. (CPT 2008, page 413;
CPT Changes: An Insider’s View 2007; Coding for Pediatrics 2008, page 88-89).
99295 represents the initial neonatal critical care code for the evaluation and management of a
critically ill neonate 28 days or less. Critically ill neonates require cardiac and/or respiratory
support (including ventilator or nasal CPAP when indicated), continuous or frequent vital sign
monitoring, laboratory and blood gas interpretations, follow-up physician reevaluations, and
30
constant observation by the health care team under direct physician supervision. Immediate
preoperative evaluation and stabilization of neonates with life threatening surgical or cardiac
conditions are included under this code (CPT 2008, page 20-21; CPT Assistant Nov 05:10;
CPT Changes: An Insider’s View 2005; Coding for Pediatrics 2008, page 96-99)
In this example the use of 31500 (endotracheal intubation) and 94610 (Surfactant
administration) is correct for these services were provided in the delivery room and is part
of the resuscitative process. Documentation must include these criteria. A -59 modifier must
be used to alert the payer that this is a distinct procedural service.
46. You attend a delivery of a 29 week infant. The infant requires resuscitation including
endotracheal intubation and positive pressure ventilation. The infant is brought to the NICU
and admitted. A UAC and UVC is placed and the child is given surfactant.
The proper codes are:
a. 99440, 35100-59, 99295, 36660, 36510, 94610
b. 99440, 99295
c. 99440, 35100-59, 99295
Answer – C
99440 represents an attendance at delivery with resuscitation including positive pressure ventilation
and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output.
(CPT 2008, page 34; CPT Assistant Apr 07:3; Coding for Pediatrics 2008, pages 90-91)
31500 is a procedure code for endotracheal intubation. (CPT 2008, page 135; CPT Assistant Aug
06:4; Coding for Pediatrics 2008, page 117). -59 modifier is used to indicate that a procedure or
service was distinct or independent from other services performed on the same day. Only use this
modifier if it best explains the circumstances and no other, more descriptive, modifier is
available. (CPT 2008, page 458; Coding for Pediatrics 2008, page 157, 163).
99295 represents the initial neonatal critical care code for the evaluation and management of a
critically ill neonate 28 days or less. Critically ill neonates require cardiac and/or respiratory
support (including ventilator or nasal CPAP when indicated), continuous or frequent vital sign
monitoring, laboratory and blood gas interpretations, follow-up physician reevaluations, and
constant observation by the health care team under direct physician supervision. Immediate
preoperative evaluation and stabilization of neonates with life threatening surgical or cardiac
conditions are included under this code (CPT 2008, page 20-21; CPT Assistant Nov 05:10;
CPT Changes: An Insider’s View 2005; Coding for Pediatrics 2008, page 96-99)
The endotracheal intubation code 31500 is used with a -59 modifier since this procedure was
part of the resuscitative process in the delivery room. The UAC (36660) and UVC (36510) are
placed in the NICU and are bundled.
31
47. You are called to the delivery of a 31 week infant delivered by c-section due to failure to
progress. Apgar scores are 6(1) and 8(5). The infant begins grunting in the delivery room. You
apply CPAP by nasal prongs. The child is admitted to the NICU on CPAP and a UAC is placed.
Within 6 hours the infant is off CPAP on room air in no further respiratory distress.
The proper codes are:
a. 99440, 99295
b. 99440, 99477, 36660
c. 99436, 99295
Answer – C
99436 represents attendance at delivery and initial stabilization of newborn. Initial drying,
stimulation, suctioning, blow-by oxygen or CPAP without positive-pressure ventilation, a cursory
visual inspection of the neonate are included in the physician work associated with this code. A
verbal request or written order and the reason for the request from the delivering physician should
be documented in the attendance note. Use of this code should not be determined by a hospital
policy but requires a request from the delivering physician. (CPT 2008, page 34, CPT Assistant
Nov 05:15, Coding for Pediatrics 2008, page 90-91).
99295 represents the initial neonatal critical care code for the evaluation and management of a
critically ill neonate 28 days or less. Critically ill neonates require cardiac and/or respiratory
support (including ventilator or nasal CPAP when indicated), continuous or frequent vital sign
monitoring, laboratory and blood gas interpretations, follow-up physician reevaluations, and
constant observation by the health care team under direct physician supervision. Immediate
preoperative evaluation and stabilization of neonates with life threatening surgical or cardiac
conditions are included under this code (CPT 2008, page 20-21; CPT Assistant Nov 05:10;
CPT Changes: An Insider’s View 2005; Coding for Pediatrics 2008, page 96-99)
The reason that 99436 is chosen rather than 99440 is that the CPAP is used to clear lung
fluid and is not positive pressure ventilation. The UAC (36660) is placed in the NICU and
is bundled. In order to use a 99295 code documentation must support the critical nature
of the baby’s illness.
48. A 35 week (2300 gram) infant is admitted to the NICU in mild respiratory distress. The infant
is placed in a 35% oxyhood and a blood gas is acceptable. A peripheral IV is started and the
child is placed on a continuous heart rate, respiratory, and saturation monitor. Blood cultures
are drawn and antibiotics are started. The initial blood glucose is 23 mg/dL and a bolus of IV
glucose is given. The glucose normalizes and the infant remains in an oxyhood in 25% oxygen
for the next two days.
The proper code for Day One is:
a. 99295
b. 99223
c. 99477
Day Two:
a. 99296
b. 99299
c. 99300
Answer – Day One - C
Answer – Day Two – B
32
99477 Initial hospital intensive care, per day, for the evaluation and management of the ill neonate,
28 days of age or less, who requires intensive observation and monitoring. Infants of any present
body weight 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 physician supervision. . (CPT 2008, page 35, CPT Changes: An
Insiders View 2008, Coding for Pediatrics 2008, page 101-104).
99299 represents a subsequent intensive care, per day, for the evaluation and management of the
recovering low birth weight infant (present body weight of 1500-2500g). These infants are not
critically ill but continue to require intensive cardiac and respiratory monitoring, continuous and/or
frequent vital sign monitoring, continuous and/or frequent vital sign monitoring, heat maintenance,
enteral and/or parenteral nutritional adjustments, laboratory and oxygen monitoring, under direct
physician supervision. From the information given this baby does not appear to be critical and there
is not a “high probability” of imminent or life-threatening deterioration of the patient’s condition.
This patient is under constant observation by the healthcare team under direct physician
supervision. CPT 2008, page 22; CPT Assistant 11/05:10. Coding for Pediatrics 2008, page 100-104
The baby as described in the vignette is not critical. A low glucose (23mg/dL) which responds
without the need for frequent changing of IV solutions or clinical symptoms make this baby
an intensive care admission (99477). On day two the baby is still considered intensive and a
weight-based code 99299 is used.
49. A mother at 25 weeks gestation enters the hospital with ruptured membranes in early labor. Her
obstetrician asks you to consult to tell her about prematurity, risks, and what to anticipate. You
go to the labor deck and review the maternal records and her hospital course up to that time.
You then speak to the mother and her husband and answer all of their questions. You write a
consult note to the obstetrician and leave a copy on the mother’s chart. The entire consult time
is 65 minutes. The time spent face-to-face is 50 minutes.
The proper code is:
a. 99404
b. 99244
c. 99253
Answer – C
99253 represents an inpatient consultation for a new or established patient, which requires these
three key components: a detailed history, a detailed examination; and medical decision making of
low complexity. In general, an inpatient consultation code is used only once by the reporting
physician for an individual hospital patient for a particular episode of care. Usually, the presenting
problem(s) are of moderate severity. Physicians typically spend 55 minutes at the bedside and on
the patient’s hospital floor or unit. Under the revised CMS consultation standards, both the
requesting and the consulting physician (or other provider) must document the request in the
medical record. (CPT 2008, page 16, CPT Assistant Sep 02:11; CPT Changes: An Insider’s View
2007, Coding for Pediatrics 2008, page 86-87).
99253 is chosen for an inpatient hospital consultation code based upon time includes pre and
post time which is added to the face-to-face time. This is different then an outpatient
33
consultation (99244). The 99404 code which is a perinatal counseling and consultation code
has no defined symptom or established illness (60 minutes). 99253 (55 minutes) is used for
99254 is 80 minutes of total time. The total time (pre, face-to-face, post) is 65 minutes. If this
time reached 80 minutes 99254 would have been correct.
50. You are called to the delivery of a 40 week gestation infant who is to be delivered by C/S due to
sustained bradycardia. At delivery the infant is apneic, bradycardic and limp. You intubate the
infant to provide ventilation. Cardiac massage is given for 30 seconds. Although the heart rate
improves, pulses are barely palpable and you insert an umbilical venous line and give a normal
saline bolus. The infant is now more stable and is admitted to the NICU for continued
respiratory failure.
The proper codes are:
a. 99440, 31500-59, 36510-59, 99295
b. 99440, 31500-25, 36510-25, 99295
c. 99436, 31500-25, 36510-25, 99295
Answer – A
99440 represents an attendance at delivery with resuscitation including positive pressure ventilation
and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output.
(CPT 2008, page 34; CPT Assistant Apr 07:3; Coding for Pediatrics 2008, pages 90-91)
31500 is a procedure code for endotracheal intubation. If the intubation is performed in the delivery
room as an essential component of the resuscitation, it is reported separately. (CPT 2008, page
135; CPT Assistant Aug 06:4; Coding for Pediatrics 2008, page 117).
36510- Catheterization of umbilical vein for diagnosis or therapy, newborn (CPT 2008, page 170;
CPT Assistant Jul 06:4; Coding for Pediatrics 2008, page 119, 218).
-25 modifier represents a significant, separately identifiable E/M service by the same physician on
the same day of the procedure or other service. The physician may need to indicate that on the day
that this procedure or service was performed, the patient’s condition required a significant
separately identifiable E/M service above and beyond the other service or procedure provided.
(CPT 2008 page 457; Coding for Pediatrics 2008 page 156, 157).
-59 modifier is used to indicate that a procedure or service was distinct or independent from other
services performed on the same day. Only use this modifier if it best explains the circumstances
and no other, more descriptive, modifier is available. (CPT 2008, page 458; Coding for Pediatrics
2008, page 157, 163).
99295 represents the initial neonatal critical care code for the evaluation and management of a
critically ill neonate 28 days or less. Critically ill neonates require cardiac and/or respiratory
support (including ventilator or nasal CPAP when indicated), continuous or frequent vital sign
monitoring, laboratory and blood gas interpretations, follow-up physician reevaluations, and
constant observation by the health care team under direct physician supervision. Immediate
preoperative evaluation and stabilization of neonates with life threatening surgical or cardiac
conditions are included under this code (CPT 2008, page 20-21; CPT Assistant Nov 05:10; CPT
Changes: An Insider’s View 2005; Coding for Pediatrics 2008, page 96-99)
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Distinguishing modifiers is sometimes difficult. A -59 modifier indicates that a procedure or
service was distinct or independent from other services performed on the same day. It is used
to identify procedures/services that NOT normally reported together but are appropriate
under the circumstances. This modifier also alerts the payer that there is a distinct
independent service performed on the same day. The -25 modifier is used when a procedure
or service identified by a CPT code is performed and the patient’s condition requires a
significant separately identifiable E/M service above and beyond the other service provided.
51. A term infant has been in the nursery for treatment of pneumonia. Today he is to be discharged.
You spend 20 minutes with the family going over discharge instructions. You also circumcise
the infant with a penile block prior to discharge.
The proper code is:
a. 99233, 54150-25, 64450-59
b. 99238, 54150-52
c. 99238, 54150-59
Answer - C
99238 Hospital discharge day management; 30 minutes or less reported by attending physician
providing discharge services on a date other than the day of admission. The reporting is based on
the total time (time does not have to be continuous) spent performing all final discharge records.
These codes may be used to report discharge services provided to patients who die during their
hospital stay. CPT 2008 page 14, CPT Assistant Sep 06:8, Coding for Pediatrics 2008 pages 58-59.
-25 modifier represents a significant, separately identifiable E/M service by the same physician on
the same day of the procedure or other service. The physician may need to indicate that on the day
that this procedure or service was performed, the patient’s condition required a significant
separately identifiable E/M service above and beyond the other service or procedure provided.
(CPT 2008 page 457; Coding for Pediatrics 2008 page 156, 157).
- 52 modifier represents reduced services. When a service or procedure is partially reduced or
eliminated at the physician’s discretion, modifier 52 should be appended to the procedure code.
This provides a mean of reporting reduced services without disturbing the identification of the basic
service. CPT 2008, page 457. Coding for Pediatrics 2008, page 161
-59 modifier is used to indicate that a procedure or service was distinct or independent from other
services performed on the same day. Only use this modifier if it best explains the circumstances
and no other, more descriptive, modifier is available. (CPT 2008, page 458; Coding for Pediatrics
2008, page 157, 163).
54150 Circumcision using the clamp or other device with regional dorsal penile or ring block.
CPT 2008, page 237, Coding for Pediatrics 2008, page 119
64450 was previously reported when a dorsal penile block was utilized. This has now been
replaced by 54150 which describes a circumcision with regional dorsal penile or ring block.
If a circumcision is done without a dorsal penile or ring block a 54150 is used with a -52
modifier which represents reduced services.
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52. This is DOL 62 for this ex 620 gm 24 week gestation male infant with history of RDS,
electrolyte abnormalities, anemia and clinical NEC. He is now 1200 gms on RA NCPAP. He
continues to have moderate episodes of bradycardia with desaturations, requiring stimulation.
He is on full gavage feeds and continues on caffeine.
The proper code is:
a. 99296
b. 99298
c. 99294
Answer - C
99294 represents a subsequent inpatient pediatric critical care, per day, for the evaluation and
management of a critically ill infant or young child, 29 days through 24 months of age. This code
is bundled and procedures may not be reported separately. (CPT 2008, page 21; CPT Assistant
Nov 05:10; CPT Changes: An Insider’s View 2005; Coding for Pediatrics 2008 pages 96-99).
The question here is whether or not this baby is critical. Documentation must again reflect
the critical nature of this baby’s illness and that withdrawal of the therapy leads to a “high
probably imminent or life threatening deterioration of the patient’s condition”. If this
perimeter is not present than 99298 a weight-based intensive care code <1500 grams would
be selected.
53. This is a day old term infant born to a mother with history of fever and ROM x 18hours. GBS
status is unknown. The neonatologist attends the delivery and admits the baby to the regular
nursery. The neonatologist draws a CBC and blood culture and infant is sent to the regular
nursery in good condition. At about 12 hours of age infant develops tachypnea and grunting.
The NNP sees the patient and after consultation with the neonatologist the patient is admitted to
the NICU. He is made NPO, an IV with D10W started. Antibiotics are begun and the baby was
placed on nasal cannula flow (1L at 25% oxygen concentration). The neonatologist sees him
the next morning. (NNP is employed by the hospital)
The initial proper code is
a. 99436, 36400-59
b. 99440, 36400
c. 99436, 36400-59, 99431
Answer – C
99436 represents attendance at delivery and initial stabilization of newborn. Initial drying,
stimulation, suctioning, blow-by oxygen or CPAP without positive-pressure ventilation, a cursory
visual inspection of the neonate are included in the physician work associated with this code. A
verbal request or written order and the reason for the request from the delivering physician should
be documented in the attendance note. Use of this code should not be determined by a hospital
policy but requires a request from the delivering physician. (CPT 2008, page 34, CPT Assistant
Nov 05:15, Coding for Pediatrics 2008, page 90-91).
36
-59 modifier is used to indicate that a procedure or service was distinct or independent from other
services performed on the same day. Only use this modifier if it best explains the circumstances
and no other, more descriptive, modifier is available. (CPT 2008, page 458; Coding for Pediatrics
2008, page 157, 163).
36400 Venipuncture, age <3 years necessitating physician’s skill, not to be used for routine
venipuncture; femoral or jugular vein. CPT 2008, page 169. Coding for Pediatrics 2008, page 89,
118.
99431 represents the history and examination of the normal newborn infant, initiation of diagnostic
and treatment programs and preparation of hospital records.. (CPT 2008, page 33; CPT Assistant
May 05:1, Coding for Pediatrics 2008, page 92, 93).
99436 is used since this is a simple attendance at delivery without resuscitation. A code for
venipuncture (36400-59) is placed the neonatologist obtains the blood sample personally.
The baby is admitted as a normal newborn (99436)
The proper code for 12 hours of age is:
a. 99477
b. 99223-21
c. no code
Answer – C
Since the NNP is employed by the hospital the neonatologist can not place a code for
supervision. Therefore there is no code offered for her service. If the NNP has her own pin
(billing) number she can submit a separate code for the admission. It is necessary to check
with State requirements which vary.
The proper code for the following morning:
a. 99300
b. 99477
c. 99223-21
Answer – B
99477 Initial hospital intensive care, per day, for the evaluation and management of the ill neonate,
28 days of age or less, who requires intensive observation and monitoring.Infants of any present
body weight 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 physician supervision. . (CPT 2008, page 35, CPT Changes: An
Insiders View 2008, Coding for Pediatrics 2008, page 101-104).
The following morning the neonatologist interacts with the patient for the first time. This
baby is not critical and therefore even though the patient was admitted to the NICU the night
before, this is the first time the physician has seen the patient in the NICU. Therefore a noncritical 99477 code is utilized.
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54. This is a day old (3150 grams) term infant born to a mother with history of fever and ROM x
18 hours. GBS status is unknown. The neonatologist attends the delivery and admits the baby
to the regular nursery. The neonatologist draws a CBC and blood culture and infant is sent to
the regular nursery in good condition. At about 12 hours of age infant develops tachypnea and
grunting. The NNP sees the patient and after consultation with the neonatologist the patient is
admitted to the NICU. He is made NPO, an IV with D10W started. Antibiotics are begun and
the baby was placed on nasal cannula flow (1L at 25% oxygen concentration). The
neonatologist sees him the next morning. (NNP is employed by the neonatal group)
The initial proper code is
a. 99436, 36400-59
b. 99440, 36400
c. 99436, 36400-59, 99431
Answer – C
99436 represents attendance at delivery and initial stabilization of newborn. Initial drying,
stimulation, suctioning, blow-by oxygen or CPAP without positive-pressure ventilation, a cursory
visual inspection of the neonate are included in the physician work associated with this code. A
verbal request or written order and the reason for the request from the delivering physician should
be documented in the attendance note. Use of this code should not be determined by a hospital
policy but requires a request from the delivering physician. (CPT 2008, page 34, CPT Assistant
Nov 05:15, Coding for Pediatrics 2008, page 90-91).
-59 modifier is used to indicate that a procedure or service was distinct or independent from other
services performed on the same day. Only use this modifier if it best explains the circumstances
and no other, more descriptive, modifier is available. (CPT 2008, page 458; Coding for Pediatrics
2008, page 157, 163).
36400 Venipuncture, age <3 years necessitating physician’s skill, not to be used for routine
venipuncture; femoral or jugular vein. CPT 2008, page 169. Coding for Pediatrics 2008, page 89,
118.
99431 represents the history and examination of the normal newborn infant, initiation of diagnostic
and treatment programs and preparation of hospital records.. (CPT 2008, page 33; CPT Assistant
May 05:1, Coding for Pediatrics 2008, page 92, 93).
99436 is used since this is a simple attendance at delivery without resuscitation. A code for
venipuncture (36400-59) is placed the neonatologist obtains the blood sample personally. The
baby is admitted as a normal newborn (99436)
The proper code for 12 hours of age is:
a. 99477
b. 99223-21
c. no code
Answer – A
38
99477 Initial hospital intensive care, per day, for the evaluation and management of the ill neonate,
28 days of age or less, who requires intensive observation and monitoring.Infants of any present
body weight 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 physician supervision. . (CPT 2008, page 35, CPT Changes: An
Insiders View 2008, Coding for Pediatrics 2008, page 101-104).
Since the NNP is employed by neonatology group she can be considered an “extension” of the
neonatologist. Therefore she can code for her service utilizing either the neonatologists ID
number or her own pin (billing) number if allowed. It is necessary to check with State
requirements which vary.
The proper code for the following morning:
a. 99300
b. 99477
c. 99223-21
Answer – A
99300 represents a subsequent intensive care, per day, for the evaluation and management of the
recovering low birth weight infant (present body weight of 2500-5000g). These infants are not
critically ill but continue to require intensive cardiac and respiratory monitoring, continuous and/or
frequent vital sign monitoring, continuous and/or frequent vital sign monitoring, heat maintenance,
enteral and/or parenteral nutritional adjustments, laboratory and oxygen monitoring, under direct
physician supervision. (CPT 2008, page 22; CPT Changes: An Insider’s View 2006. Coding for
Pediatrics 2007, page 259).
The neonatologist sees the patient the following morning and even though this is the initial
NICU encounter he has already been credited with the admission the night before as the NNP
is part of the neonatal group. The weight-based 99300 code is appropriate.
55. You are called to the delivery room to attend a delivery of a full term infant with a history of
fetal distress and maternal pre-eclampsia. A stat C/S section is done with Apgar Scores of 6/8
at 1 and 5 minutes. Infant required suctioning and blow-by 02. Physical exam appeared to be
normal except some mild hypotonia. Infant was observed in the NICU for 3 hours and then sent
to the regular nursery.
The proper codes are:
a. 99440, 99431
b. 99436, 99431
c. 99436, 99223
Answer – B
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99436 represents attendance at delivery and initial stabilization of newborn. Initial drying,
stimulation, suctioning, blow-by oxygen or CPAP without positive-pressure ventilation, a cursory
visual inspection of the neonate are included in the physician work associated with this code. A
verbal request or written order and the reason for the request from the delivering physician should
be documented in the attendance note. Use of this code should not be determined by a hospital
policy but requires a request from the delivering physician. (CPT 2008, page 34, CPT Assistant
Nov 05:15, Coding for Pediatrics 2008, page 90-91).
99431 represents the history and examination of the normal newborn infant, initiation of diagnostic
and treatment programs and preparation of hospital records.. (CPT 2008, page 33; CPT Assistant
May 05:1, Coding for Pediatrics 2008, page 92, 93).
99436 is used as this is a delivery which was attended without the need for resuscitation.
Suctioning and blow-by oxygen are parts of the 99436 code. The baby was observed in the
NICU although not admitted. The place of service does not determine the code. Therefore
the 99431 (normal newborn code) is appropriate.
56. Baby Boy Meyers, an 1190 gm infant at 29 weeks gestation is born at 1 AM. The delivery is
attended by a neonatal nurse practitioner (NNP) who is employed by the hospital but works
under the supervision of the neonatologist. The infant has respiratory distress and is intubated
in the delivery room and given surfactant. The infant is admitted to the NICU and soon is
extubated to CPAP. You are called by the NNP and informed about the delivery and the
infant’s condition. Management of the infant is discussed. You initially see and examine the
infant at 7 AM, at which time the infant is now in an oxyhood in 40% oxygen. A peripheral
IV is in place and the infant is receiving antibiotics.
The proper CPT code(s) for is:
a. 99436, 99295
b. 99440, 31500-59, 99295
c. 99477
Answer - C
99477 Initial hospital intensive care, per day, for the evaluation and management of the ill neonate,
28 days of age or less, who requires intensive observation and monitoring.
Infants of any present body weight 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 physician
supervision. . (CPT 2008, page 35, CPT Changes: An Insiders View 2008, Coding for Pediatrics
2008, page 101-104).
Since the NNP is employed by the hospital the neonatologist can not code for the delivery.
When the NNP is involved with the infant the baby is critical. However the first time the
neonatologist examines the baby (at 7am) the infant is clearly not critical. Therefore although
we are taught to utilize the highest acuity code for the day, at the time the baby becomes the
neonatologist patient he is not critical.
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