Assigning Neonatal ICU Codes

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Assigning Neonatal ICU Codes

Kathleen A. Mundy, BS, RN, CCS, CPC

Kathleen Mundy

A great deal of confusion has surrounded the use of neonatal intensive care unit (NICU) codes and their definitions. More specifically, at what point after the NICU admission (99295) does the physician stop submitting the subsequent neonatal intensive care codes (99296 and 99297) and start using the subsequent hospital care codes (99231-99233)?

Before 1996, neonatal intensive care codes (99295-99297) were used to report the services of physicians who were directing neonate care in a NICU. That year the American Medical Association (AMA) revised these code definitions to identify all of the care and procedures performed during a NICU stay. These definitions now describe the type of care provided, rather than the location. Under the new definitions, physicians can submit codes 99295, 99296 and 99297 for the performance of services in locations other than the designated NICUs (e.g., pediatric ICU). (See the table.)

In addition, the codes now include the descriptor “under direct physician supervision.” This means that the neonatologist must be physically present to see the patient and must be readily available to the health care team if needed. The neonatologist does not have to be present for a 24-hour period, but he or she must be physically present at some time during this period.

The NICU codes are per-day codes reported by physicians providing the type of care detailed in the code descriptions. They represent care starting with the NICU admission date and may be reported only once per day.

The following services are included in these codes: enteral and parenteral nutritional maintenance, metabolic and hematologic maintenance, pharmacologic control of the circulatory system, parental counseling, team conferences, telephone calls and personal direct supervision of the health care team.

The following procedures also are included as part of the global NICU service: umbilical, central or peripheral vessel catheterization; oral or nasogastric tube placement; endotracheal intubation; lumbar puncture; suprapubic bladder aspiration; bladder catheterization; initiation and management of mechanical ventilation or continuous positive airway pressure (CPAP); surfactant administration; intravascular fluid administration; transfusion of blood components; vascular punctures; invasive or noninvasive electronic monitoring of vital signs; bedside pulmonary function testing; and monitoring/interpretation of blood gases or oxygen saturation. Report any services and/or procedures not listed separately.

As you can see in the table, the NICU admission and subsequent neonatal intensive care provided refer to neo-nates who are critically ill, critically ill and unstable, or critically ill though stable. The codes describe the evaluation and management of these patients. The subsequent neonatal codes describe intensive care provided on dates subsequent to the admission date.

When do you use the subsequent hospital visit codes? This is probably the hardest to determine, but the following basic guidelines may help. It is correct to use hospital visit codes when the patient is no longer considered critical, no longer on a ventilator, no longer intubated and no longer NPO (nothing by mouth). In addition, the patient is over the acute phase of the initial problem, and patient care is being provided prior to discharge out of the neonatal ICU.

Kathleen A. Mundy is a senior health care consultant with Medical Learning Inc. (MedLearn), St. Paul, MN.

Neonatal ICU Codes, Status and Required Care

CPT Code 99295

Critically ill and admission to the NICU

Patient Status:

* Critically ill neonate

* Initial date of admission

* Unstable cardiopulmonary status

* Constant attendance of the physician

* Constant observation of the health care team under supervision of


Care Required:

* Cardiopulmonary monitoring and support

* Initiation of mechanical ventilation or CPAP

* Surfactant administration

* Pharmacological control of circulatory system

* Intravascular fluid administration

* Transfusion of blood components

* Vascular punctures and blood gas interpretation

CPT Code 99296

Critically ill and unstable, subsequent visit

Patient Status:

* Unstable cardiopulmonary metabolic status

* Possible unstable neurological status

* Requires frequent ventilator changes

* Requires frequent IV changes

* Changing condition almost minute-to-minute

* Almost constant attention by the neonatologist

Care Required:

* Mechanical ventilation or CPAP

* Surfactant administration

* Pharmacological control of the circulatory system

* Total parenteral nutrition

* Seizure management

* Invasive/noninvasive monitoring of vital signs

* Monitoring of blood gases or oxygen saturation

CPT Code 92927

Critically ill and stable, subsequent visit

Patient Status:

* Still intubated

* Requires invasive cardiopulmonary monitoring but vital signs are stable

* Not having seizures

* Metabolic status stable but still NPO and receiving parenteral

nutrition and IV medications

* Not yet over the acute phase of the initial problem

Care Required:

* Ventilation support and treatment as necessary

* Total parenteral nutrition

* Invasive or noninvasive electronic monitoring of vital signs

* Apnea management or monitoring of blood gases or oxygen saturation

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