Also, in CPT 2005, there was an important change in the ages associated with the NICU and PICU codes as follows:

99293 Initial pediatric critical care, 31 days up through 24 months of age, per day, for the evaluation and management of a critically ill infant or young child , 29 days through 24 months of age

99394 Subsequent pediatric critical care, 3 1 days up through 24 months of age, per day, for the evaluation and management of a critically ill infant or young child , 29 days through 24 months of age

99295 Initial neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 30 28 days of age or less

99296 Subsequent neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 30 28 days of age or less

Our rationale for this change was as follows:

"The Official ICD-9-CM Guidelines for Coding and Reporting define the neonatal period as "beginning at birth and lasting through the 28th day following birth." This is also the definition utilized by the World Health Organization (WHO), the American College of Obstetricians and Gynecologists (ACOG), and the American Academy of Pediatrics (AAP). However, the current CPT codes for Neonatal and Pediatric Critical Care Services (99293-99296) utilize an alternative definition of a neonate as being "30 days of age or less." This inconsistency between the two nomenclature systems results in confusion for both physicians and insurance carriers. Presently, care for a critically ill patient who is 29 days of age is reported using a neonatal CPT code and a non-neonatal ICD-9-CM code(s).

Further, Stedman's Medical Dictionary (25th Edition) defines the neonatal period as "immediately succeeding birth and continuing through the first 28 days of life." The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and ACOG define a neonate as "less than or equal to 28 days." WHO defines the neonatal period as "up to and including 27 days, 23 hours, and 59 minutes from the moment of birth."

When the American Academy of Pediatrics (AAP) originally presented its proposal for new Neonatal Critical Care codes, the 28-day definition was utilized. The CPT Editorial Panel and the payor representatives felt that 28 days would be too confusing for payors even though the WHO and JCAHO standards were discussed with the Panel during the presentation. We now respectfully request that the Panel consider eliminating the inconsistency between the two HIPAA standard coding sets of CPT and ICD-9-CM."

In November 2003, the CPT Editorial Panel approved this as an editorial revision (this means that the codes will NOT be subject to revaluation) effective January 1, 2005.