Home | AAP Pediatric Coding Newsletter | AAP Point-of-Care ...
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|141 Northwest Point Blvd | |
|Elk Grove Village, IL 60007-1019 |March 3, 2012 |
|Phone: 847/434-4000 | |
|Fax: 847/434-8000 |To Whom It May Concern: |
|E-mail: kidsdocs@ | |
| |I am writing on behalf of the 60,000 members of the American Academy of Pediatrics to object to your practice of inappropriately |
|Executive Committee |bundling certain procedures when they are reported on the same day as a global neonatal critical care code (99468-99469). |
|President | |
|Robert W. Block, MD, FAAP |Issue #1: Procedures Performed in the Delivery Room |
|President-Elect |While the neonatal critical care codes bundle commonly performed services such as endotracheal intubation (31500) and umbilical |
|Thomas K. McInerny, MD, FAAP |venous catheterization (36510), it is appropriate to report such procedures separately from 99468 (initial neonatal critical care, |
|Immediate Past President |per day, for the evaluation and management of a critically ill neonate, 28 days of age or younger) when they are performed as a |
|O. Marion Burton, MD, FAAP |necessary component of the pre-admission delivery room care. CPT guidelines state that “other procedures performed as a necessary |
|Executive Director/CEO |part of the resuscitation (eg, endotracheal intubation [31500]) are also reported separately when performed as part of the |
|Errol R. Alden, MD, FAAP |pre-admission delivery room care (CPT 2012, AMA Professional Edition, page 39) from the initial day neonatal critical care code. |
|Board of Directors | |
|District I |Some carriers attempt to limit reimbursement by incorrectly interpreting the neonatal critical care CPT guidelines. The National |
|Carole E. Allen, MD, FAAP |Correct Coding Initiative (NCCI) Edits specifically allow the reporting of any of the neonatal critical care codes with any of their |
|Arlington, MA |bundled procedures as long as the appropriate modifier is appended. For example, during neonatal resuscitation or as part of airway |
|District II |suctioning for meconium, an endotracheal intubation (31500) may be indicated. Since delivery room care and management is considered |
|Danielle Laraque, MD, FAAP |“pre-admission,” the procedures performed during that period of service in the delivery room are not considered bundled into the |
|Brooklyn, NY |neonatal critical care codes that commence only after the nursery admission, even if they are reported on the same calendar day. In |
|District III |this situation, code 31500 should be appended with the modifier 59 (distinct procedural service), indicating that in this particular |
|Sandra Gibson Hassink, MD, FAAP |situation it is a separate service from 99468. |
|Wilmington, DE | |
|District IV |Issue #2: Evaluation and Management Services Provided in the Delivery Room |
|Francis E. Rushton, Jr, MD, FAAP |Since the inception of the neonatal critical care codes, it has always been appropriate to report attendance at delivery (99464) or |
|Beaufort, SC |newborn resuscitation (99465) evaluation and management (E/M) codes in addition to the initial day neonatal critical care code |
|District V |(99468). Recently, certain carriers have started to inappropriately bundle 99464 or 99465 with 99468. CPT guidelines state that “the |
|Marilyn J. Bull, MD, FAAP |initial day neonatal critical care code can be used in addition to 99464 or 99465 as appropriate, when the physician is present for |
|Indianapolis, IN |the delivery (99464) or resuscitation (99465) is required.” (CPT 2012, AMA Professional Edition, page 39). Further, there are no NCCI|
|District VI |Edits on the reporting of 99464 or 99465 with 99468. This indicates that Medicare payment policy does not require the appending of a |
|Michael V. Severson, MD, FAAP |modifier to allow reimbursement for both services. |
|Shakopee, MN | |
|District VII |I urge you to reconsider your position on this issue. Thank you. |
|Kenneth E. Matthews, MD, FAAP | |
|College Station, TX |Sincerely, |
|District VIII |Margie Andreae, MD, FAAP |
|Kyle Yasuda, MD, FAAP |AAP Committee on Coding and Nomenclature |
|Seattle, WA | |
|District IX | |
|Myles B. Abbott, MD, FAAP | |
|Berkeley, CA | |
|District X | |
|Sara H. Goza, MD, FAAP | |
|Fayetteville, GA | |
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