Bust 4 Myths About Pediatric Critical Care Services
Posted on 10. Jun, 2009 by Editor in Hot Coding Topics
MYTHBUSTER: Codes 99291, +99292 apply to infants, young pediatric patients in these situations.
You’ve got to expand your 99291 and +99292 use, or you’ll join other pediatric practices that waste money appealing denials for legit per diem critical care.
“Currently, we are being denied [on claims for 99468, Initial inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or less] and having to send records and request a review … which is very time-consuming and costly,” reports Tommie Angel, practice manager at Sanford Pediatrics PA in North Carolina.
Strategy: Consider additional factors such as setting and time, before choosing 99291, +99292 (Critical Care Services: Adult [Over 24 Months of Age]) or 99466-99476 (Neonatal and Pediatric Critical Care Services). Check out these instances when 99291, +99292 are the right choice for infants and young pediatric patients.
Myth 1: 99291, 99292+ Are for 25 Months and Older
Reality: In three cases, you can apply Critical Care Services for patients less than 25 months of age. Looking at an E/M table or one CPT directive can mislead you into pigeonholing 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and +99292 (… each additional 30 minutes [List separately in addition to code for primary service]) as adult-only codes.
Table 1 of the E/M services guidelines in CPT 2009 lists 99291-+99292’s category/subcategory as “Critical Care Services: Adult [Over 24 Months of Age].” The directive describes the most common use of the codes and is not a restriction.
CPT’s Critical Care Services guidelines indicate...
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