2025 CPT code 99468
Initial inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or younger.
Modifier 25 can be appended if significant, separately identifiable E/M services are provided by the same physician on the same day.
Medical necessity for this code requires that the neonate is critically ill and requires constant attention in a neonatal intensive care unit setting.
The physician provides initial evaluation, management, and critical care interventions for a critically ill newborn in a neonatal intensive care unit setting.This might include managing premature infants, infants with low birth weight, or those with congenital abnormalities.
- Evaluation and Management, Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services
In simple words: This code covers the doctor's work on the first day of intensive care for a critically ill newborn up to 28 days old. It includes the doctor's evaluation, management, and certain necessary procedures.
This code encompasses the initial day of critical care for a critically ill neonate aged 28 days or less. It includes evaluation and management services and can only be reported by a single physician once per hospital admission, per patient, per day. If the neonate is readmitted for critical care during the same hospital stay, subsequent days are reported with code 99469.It can be used in conjunction with delivery (99464) or resuscitation (99465) codes when the physician is present. This code includes procedures such as invasive or non-invasive electronic monitoring of vital signs, vascular access procedures, airway and ventilation management, blood gas monitoring, and transfusions.
Example 1: A premature infant born at 26 weeks gestation requires respiratory support and continuous monitoring. The physician directing their care in the NICU would report 99468 for the first day of care., A newborn with a congenital heart defect requires immediate surgery and post-operative critical care.The physician overseeing their care in the NICU would use 99468., A 10-day-old infant develops sepsis and requires intensive monitoring and treatment in the NICU. The physician in charge would report 99468 for the initial day of NICU care.
Documentation should support the medical necessity of critical care, including details of the infant's condition, interventions performed, and continuous monitoring. This may include vital signs, ventilator settings, lab results, and physician progress notes.
- Revenue Code: M2C - HOSPITAL VISIT - CRITICAL CARE
- Specialties:Neonatology, Critical Care Pediatrics
- Place of Service:Inpatient Hospital