Question

question 14

an infant is born six weeks premature in rural arizona and the pediatrician in attendance intubates the child and administers surfactant in tube while waiting in the er for the air ambulance. during the 45-minute wait, he continues to bag the critically ill patient on 100 percent while monitoring vs, ecg, pulse oximetry and temperature. the infant is in a warming unit and an umbilical vein line was placed for fluids of emergent need for medications. how is this coded?

99471-25, 94610, 36510
99471
99291
99291-25, 31500, 36510, 94610

Explanation:

Analyze patient status and care setting

The patient is a critically ill premature infant receiving emergency care in the ER while waiting for an air ambulance. Because the care is provided in an outpatient/emergency department setting (ER) rather than an inpatient neonatal intensive care unit (NICU), inpatient neonatal critical care codes (such as 99471) do not apply. Instead, hourly critical care codes (99291) must be used.

Evaluate procedures performed and bundling rules

The pediatrician performs critical care for 45 minutes (coded with 99291). During this time, the physician also performs endotracheal intubation (31500), places an umbilical vein line (36510), and administers surfactant (94610). Under CPT guidelines, these specific procedures are not bundled into the hourly critical care code 99291 and can be billed separately.

Determine appropriate modifiers

To report both the critical care evaluation and management (E/M) service and the separate procedures performed on the same day, modifier -25 must be appended to the critical care code (99291-25) to indicate a significant, separately identifiable E/M service.

Answer:

• 99471-25, 94610, 36510
• 99471
• 99291
• 99291-25, 31500, 36510, 94610 (Correct answer)