Initial Inpatient Neonatal Intensive Care and Other Services

Good morning! Does anyone know if/what the age restriction is for codes 99478-99480? I have claims that are getting denied stating that these codes are not compatible with the patient's age. Any help would be most appreciated! Thank you.

Michelle

age edits

Use for the recovering very low birth weight infant. Bill with appropriate code according to infant weight

Age edits

Nancy,

That is what we have been billing based on, but the insurance carrier is stating that the CPT code (such as 99480) is not compatible with the patient's age, even the patient is an infant! I just wanted to make sure that we weren't missing something. We are now going to request a meeting with our rep from that insurance company to try and get this resolved. We are talking about a huge amount of claims.

Thanks for your input!

Michelle

intensive care, not critical

How old is the patient? They may be looking at neonatal period - the first 28 days of life.
These codes are used to report care subsequent to the day of admission provided by a neonatologist directing the continuing intensive care of the very low birthweight infant who no longer meets the definition of being critically ill. Low birthweight services are reported for neonates less than 2500 grams who do not meet the definition of critical care but continue to require intensive observation and frequent services and intervention only available in an intensive care setting. Services provided to these infants exceed those available in less intensive hospital areas of medical floors. These infants require intensive cardiac and respiratory monitoring, continuous and/or frequent vital signs monitoring, heat maintenance, enteral and/or parenteral nutritional adjustments, laboratory and oxygen monitoring and constant observation by the health care team under direct supervision.