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Neonatology consultation program coding

Journal of Perinatology (2024)Cite this article

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Morrison et al., present a comprehensive approach to a neonatology consultation program, with emphasis on the contribution of neonatal medicine in the ongoing care of our most fragile patients in a variety of patient settings [1]. However, contrary to listing of Current Procedural Terminology (CPT) codes listed in Table 2 of the Morrison et al. manuscript, the use of daily global codes are limited to the primary team and not appropriate for a consultative service. Initial (CPT code – 99477) and weight-based subsequent intensive care codes (99478-99480) should only be used by the primary medical team, not the consultative team [2]. Furthermore, CPT codes are not location dependent (patients outside an ICU receiving critical care can be billed with critical care codes), nor are they provider specialty dependent (hospitalists are allowed to bill critical and intensive care codes if they provide such service) [3, 4].

A consultation is a type of evaluation and management service provided at the request of another physician or qualified health care professional to provide recommendations or care for a specific condition or problem. Documentation of a consult for billing must include the name of the health care professional requesting the consultation and the reason for the consultation [5].

A consultation is a type of evaluation and management service provided at the request of another physician or qualified health care professional to provide recommendations or care for a specific condition or problem. Documentation of a consult for billing must include the name of the health care professional requesting the consultation and the reason for the consultation [5].

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References

  1. Morrison TM, Forget A, Keyes M, Sullivan A, Kelley J, Katz J, et al. Establishing a neonatology consultation program: extending care beyond the neonatal intensive care unit. J Perinatol. 2024;44:458–63.

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  2. Lakshminrusimha S, Song C, Pearlman SA, Martin G, Duncan S. Controversies in CPT(R) coding in the neonatal intensive care unit: - critical vs. intensive care. J Perinatol. 2023;43:1535–40.

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  3. Duncan S, Martin G, Pearlman SA. Quick Reference Guide to Neonatal Coding and Documentation. AAP - American Academy of Pediatrics: Itasca, IL, 2016.

  4. Cindy Huges, Stefanie Muntean-Turner, Teri Salus (eds). Coding examples: neonatal critical care and intensive care services. AAP Pediatr Coding News. 2024;19:8–10.

  5. AAP. Coding for Pediatrics 2024: A Manual for Pediatric Documentation and Payment - American Academy of Pediatrics Committee on Coding Nomenclature. American Academy of Pediatrics, 2024.

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Acknowledgements

The authors thank the members of the AAP SONPM Committee on Neonatal Coding for their input.

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Authors and Affiliations

  1. Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA

    Scott D. Duncan

  2. Chair, Committee on Neonatal Coding, American Academy of Pediatrics – Section on Neonatal Perinatal Medicine (AAP SONPM), Itasca, MN, USA

    Scott D. Duncan

  3. Department of Pediatrics, UC Davis Children’s Hospital, Sacramento, CA, USA

    Satyan Lakshminrusimha

Authors
  1. Scott D. Duncan
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  2. Satyan Lakshminrusimha
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SDD wrote the initial draft of the manuscript, SL conceptualized and revised the draft. All authors approve the final version of the manuscript.

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Correspondence to Satyan Lakshminrusimha.

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Duncan, S.D., Lakshminrusimha, S. Neonatology consultation program coding. J Perinatol (2024). https://doi.org/10.1038/s41372-024-01992-6

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