Anthem Central Region
Clinical Claims Edit
Please compare the claim's date of adjudication to the range of the edit in question. Prior versions , if
any, can be found below.
Subject: Physician Standby Service with Neonatal Critical Care Services
Edit #: 335
Effective Date: 9/15/2003-1/1/2009 (Enddated)
Status: Current
Last Review Date: 8/21/2003
Edit
99360 (Physician standby service, requiring prolong physician attendance, each 30 minutes {e.g., operative
standby, standby for frozen section, for cesarean/high risk delivery, for monitoring EEG), 99436
(Attendance at delivery (when requested by delivery physician) and initial stabilization of newborn) and
99440 (Newborn resuscitation: provision of positive pressure ventilation and/or chest compressions in the
presence of acute inadequate ventilation and/or cardiac output) does not bundle with 99295 (Initial
neonatal critical care, per day for the evaluation and management of a critically ill neonate, 30 days of age
or less).
99360 (Physician standby service, requiring prolong physician attendance, each 30 minutes {e.g., operative
standby for frozen section, for cesarean/high risk delivery, for monitoring EEG) bundles with 99436
(Attendance at delivery (when requested by delivery physician) and initial stabilization of newborn).
99436 (Attendance at delivery (when requested by delivery physician) and initial stabilization of newborn)
bundles with 99440 (Newborn resuscitation: provision of positive pressure ventilation and/or chest
compressions in the presence of acute inadequate ventilation and/or cardiac output).
92950 (Cardiopulmonary resuscitation {e.g. ,, cardiac arrest}) and 99440 (Newborn resuscitation: provision
of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation
and/or cardiac output) does not bundle with 99289 or 99290 (Critical care services delivered by a
physician, face-to-face, during an interfacility transport of critically ill or critically injured pediatric patient,
24 months of age or less; first 30-74 minutes and each addition 30 minutes).
92950 (Cardiopulmonary resuscitation {e.g., cardiac arrest} does not bundle with 99291 or 99292 (Critical
care, evaluation and management of the critical ill or injured patient, first 30-74 minutes or each additional
30 minutes), 99293 or 99294 (Initial or Subsequent pediatric critical care, 31 days up through 24 months of
age, per day, for the evaluation and management of a critically ill infant or young child), 99296 (Subsequent
neonatal critical care, per day, for the evaluation and management of a critically ill neonate 30 days of age
Claims edits adjudicate according to the edits active in the claims processing system on the date the claim was processed. Anthem
reserves the right to periodically review and update claims edits.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic,
mechanical photocopying, or otherwise, without permission from Anthem Insurance Companies, Inc.
 CPT Only – American Medical Association
Page 1 of 4
Edit # 335
Anthem Central Region
Clinical Claims Edit
or less), 99298 (Subsequent intensive care, per day for the evaluation and management of the recovering
very low birth weight infant {present body weight less than 1500 grams), and 99299 (Subsequent intensive
care, per day for the evaluation and management of the recovering low birth weight infant {present body
weight of 1500-2500 grams).
CODE
99360
99436 (Deleted)
99440 (Deleted)
99360
99436 (Deleted)
92950
99440 (Deleted)
92950
RULE
Separate Reimbursement
Redundant/Mutually Exclusive
Redundant/Mutually Exclusive
Separate Reimbursement
Separate Reimbursement
CODE
99295 (Deleted)
99436 (Deleted)
99440
99289 (Deleted)
99290 (Deleted)
99291
99292
99293 (Deleted)
99294 (Deleted)
99296 (Deleted)
99298 (Deleted)
99299 (Deleted)
Rationale for Edit:
Anthem Central Region does not bundle 99360, 99436 or 99440 with 99295. Based on the 2003 CPT Manual,
"The initial day<neonatal critical care code >(99295) can < be used in addition to codes 99360,
99436 or 99440 as appropriate, when the physician is present for the delivery and newborn
resuscitation is required"
Based on the National Correct Coding Guide, codes 99360, 99436 or 99295 are not listed as component
codes to 99295. Therefore, if 99360, 99436, or 99440 is submitted with 99295--both reimburse separately.
Anthem Central Region bundles 99360 as redundant/mutually exclusive with 99436. Based on the 2003 CPT
manual, "(99360 may not be reported in addition to 99436)". Based on the National Correct Coding Guide,
code 99360 is listed as a component to code 99436. Therefore, if 99360 is submitted with 99436--only
99436 reimburses.
Anthem Central Region bundles 99436 as redundant/mutually exclusive with 99440. Based on the 2003 CPT
manual, "99436 may not be reported in addition to 99440". Based on the National Correct Coding Guide,
code 99436 is listed as a component code 99440. Therefore, if 99436 is submitted with 99440--only 99440
reimburse.
Claims edits adjudicate according to the edits active in the claims processing system on the date the claim was processed. Anthem
reserves the right to periodically review and update claims edits.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic,
mechanical photocopying, or otherwise, without permission from Anthem Insurance Companies, Inc.
 CPT Only – American Medical Association
Page 2 of 4
Edit # 335
Anthem Central Region
Clinical Claims Edit
Anthem Central Region does not bundle 92950 or 99440 with 99289 or 99290. Based on the 2003 CPT manual,
there are a list of services that are included when performing 99289 and 99290. Since 92950 or 99440 are
not one of these services listed as being included in 99289 and 99290; then these services are to be
reported separately. Therefore, if 92950 or 99440 is submitted with 99289 and 99290--both reimburse
separately.
Anthem Central Region does not bundle 92950 with 99291, 99292, 99294, 99296, 99298 or 99299. Based on CPT
Assistant article:
"Question:
If cardiopulmonary resuscitation and critical care services are performed on the same day by the
same physician, can I code both services?
AMA Comment:
From a CPT coding perspective it is appropriate for a physician to report CPT code 92950 (for the
CPT) and 99290 and 99291 (for the critical care services). Both services should be clearly
documented in the medical record. Specific guidelines clarify the services included and excluded
from critical care and can be found on page 27 and 28 of CPT 1996."
Based of the 2003 CPT manual code 92950 is not one of the codes listed as being included in critical care,
neonatal and pediatric critical care or in intensive {non-critical care} low birth weight services. Based on
2003 CPT manual, "Codes 99298-99299 are global 24 hour codes with the same services bundled as
outline under codes 99293-99296. Based on the National Correct Coding Guide, code 92950 is not listed as
a component code to codes 99291, 99292, 99293, 99294, 99296, 99298 or 99299. Therefore, if code 92950
is submitted with 99291, 99292, 99293, 99294, 99296, 99298 or 99299--both reimburse separately.
Reference Information:
1. American Medical Association. Neonatal and Pediatric Critical Care Services. Current Procedural
Terminology CPT 2003. 2003:21-22.
2. American Medical Association. Physician Standby Services. Current Procedural Terminology CPT
2003. 2003:28.
3. American Medical Association. Newborn Care. Current Procedural Terminology CPT 2003. 2003:31.
4. American Medical Association. Pediatric Critical Care, Patient Transport. Current Procedural
Terminology CPT 2003. 2003:19.
5. American Medical Association. Cardiopulmonary Resuscitation, 92950, 99291 (Q&A). CPT
Assistant; January 1996; 6(1): 7.
Claims edits adjudicate according to the edits active in the claims processing system on the date the claim was processed. Anthem
reserves the right to periodically review and update claims edits.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic,
mechanical photocopying, or otherwise, without permission from Anthem Insurance Companies, Inc.
 CPT Only – American Medical Association
Page 3 of 4
Edit # 335
Anthem Central Region
Clinical Claims Edit
6. American Medical Association. Critical Care Services. Current Procedural Terminology CPT 2003.
2003:20-21.
7. Ingenix, Inc. Evaluation and Management Services. National Correct Coding Guide. (9.0): Medicine
34-35.
Claims edits adjudicate according to the edits active in the claims processing system on the date the claim was processed. Anthem
reserves the right to periodically review and update claims edits.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic,
mechanical photocopying, or otherwise, without permission from Anthem Insurance Companies, Inc.
 CPT Only – American Medical Association
Page 4 of 4
Edit # 335