Payers denying 99465-25? Here’s help straight from the AMA Symposium in Chicago.
Question: There’s a notation in the CPT 2009 manual that the neonatal critical care codes include delivery room resuscitation. Is this true?
Answer: No, a parenthetical note following 99465 (Delivery/birthing room resuscitation, provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output) incorrectly stated that resuscitation could not be reported with other per day critical care services, said Peter A. Hollmann, MD, AMA CPT Editorial Panel, Vice Chair in his “Evaluation and Management” presentation at the AMA CPT and RBRVS 2010 Annual Symposium in Chicago on Nov. 12.
You can separately report 99465-25 (Significant, separately identifiable evaluation and management service provided by the same physician on the same day of the procedure or other service) provided the resuscitation in the delivery room is provided as a medically necessary service and not as a convenience prior to moving the patient to the neonatal intensive care unit (NICU) for critical care (99468, Initial inpatient neonatal critical care, per day, of r the evaluation and management of a critically ill neonate, 28 days of age or younger) or intensive care (99477, Initial hospital care, per day, for the evaluation and management of the neonate, 28 days of age or younger, who requires intensive observation, frequent interventions, and other intensive care services).
An errata published on the AMA Web site listed this error in January 2009. But the printed incorrect instruction that appeared in the CPT 2009 manual caused confusion for Medicaid contractors, payers, and coders alike.
Good news: “In CPT 2010, the AMA corrects that instruction.” Code 99465’s revised note indicates “99465 may be reported in conjunction with 99460, 99468, 99477.”
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