Efficient Reimbursement and Medical Billing and Coding -- Just my One Cent!

Know your contracted fees (very important!). Be careful with multiple procedures, bilateral, per spinal level, etc etc. You have to know how to properly code these procedures. Drugs and supplies, radiology (S&I) should also be billed if they are billable separately. --- analyze your EOB, were you appropriately reimbursed? Bilateral procedures for instance (mostly!!) are paid at 150% based on the allowed amount. Appropriate modifier(s) should be appended though. Always be aware of your payors' policy on modifiers.

On top of it all, documentation and meeting medical necessity are very important to be successful with reimbursement. I truly believe, there's no way claims should be denied for reimbursement if it was rendered, documented and have met medical necessity. Your knowledge with clinical coverage and determination and utilization guidelines are also very important when you appeal those claims.

Remember, if it wasn't documented --- the service/procedure was never rendered at all!

2009 New, Revised and Deleted Codes Inpatient Neonatal and Pediatric Critical Care

Deleted CODES and New Codes:

99295 has been deleted. New Code is 99468 - Initial inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or less

99296 has been deleted. New Code is 99469 - Subsequent inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or less

99293 has been deleted. New Code is 99471 - Initial inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 29 days through 24 months of age

99294 has been deleted. New Code is 99472 - Subsequent inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 29 days through 24 months of age

99298 has been deleted. New Code is 99478 - Subsequent intensive care, per day, for the
evaluation and management of the recovering very low birth weight infant (present body weight of less than 1500 grams)

99299 has been deleted. New Code is 99479 - Subsequent intensive care, per day, for the
evaluation and management of the recovering low birth weight infant (present body weight of 1500-2500 grams)

99300 has been deleted. New Code is 99480 - Subsequent intensive care, per day, for the
evaluation and management of the recovering low birth weight infant (present body weight of less than 2501-5000 grams)


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Reference/Source: CPT Code Book 2009 (AMA) , CPT 2009 Changes an Insider's View (AMA)
*** CPT codes and its descriptions are copyrights, owned, maintained and is a trademark of the
AMA (American Medical Association).
*** Always consult your CPT Code Book!
*** Get more information on clinical guidelines and policies from your local CMS carriers and