Certain codes in Current Procedural Terminology (CPT) include age ranges. These codes are selected based on the patient’s age on the date that the service is provided.
It is important to accurately recognize the ages included in the assigned ranges. For example, different codes are assigned to daily critical care services provided to neonates (99468–99469) and other children younger than 6 years (99471–99476). Application of the wrong CPT code may result in claim rejection or denial due to mismatch in the child’s age and the code reported.
Pediatric critical care codes (99471–99472; 99475–99476) are reported for critical care services provided to an infant or child who is no longer a neonate (28 days or younger) and not yet 6 years old. The inpatient pediatric critical care codes are described as follows:
Some confusion has been noted about the endpoint for reporting...