2025 CPT code 99477
(Active) Effective Date: N/A Revision Date: N/A Evaluation and Management - Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services Feed
Initial hospital care, per day, for the evaluation and management of the neonate, 28 days of age or younger, who requires intensive observation, frequent interventions, and other intensive care services.
Modifier 25 may be used if a significant, separately identifiable E/M service by the same physician is performed on the same day.
Medical necessity for 99477 is established when a neonate requires a level of care beyond routine newborn care but does not meet the criteria for critical care. The documentation should clearly demonstrate the need for intensive observation, frequent interventions, and continuous monitoring due to the infant's condition.
The physician or other qualified healthcare professional is responsible for the initial evaluation, management, and supervision of the neonate's care, including ordering and interpreting diagnostic tests, adjusting treatment plans, and coordinating with the healthcare team.
In simple words: This code covers the doctor's work on the first day of a newborn's hospital stay (up to 28 days old) when the baby needs close monitoring, frequent medical procedures, and other intensive care, but is not considered critically ill. This includes things like constant heart and breathing checks, regular temperature control, help with feeding, and close observation by the medical team.
This code encompasses the initial day of inpatient hospital care for a neonate (28 days old or younger) requiring intensive observation, frequent interventions, and other intensive care services, but not meeting the criteria for critical care.Services typically include intensive cardiac and respiratory monitoring, frequent vital signs checks, thermoregulation, nutritional adjustments, laboratory and oxygen monitoring, and constant observation by a healthcare team under the supervision of a physician or other qualified healthcare professional.
Example 1: A 2-week-old infant born prematurely is admitted for respiratory distress and requires continuous oxygen monitoring, frequent suctioning, and intravenous fluids. The physician oversees the care and adjusts treatment based on the infant's response., A newborn experiencing feeding difficulties requires close monitoring of weight, nutritional intake, and electrolyte balance.The physician directs the care team in providing enteral or parenteral nutrition and evaluates the infant's progress., A neonate with suspected sepsis is admitted for observation and requires frequent vital signs checks, laboratory tests, and intravenous antibiotics. The physician supervises the infant's care and modifies the treatment plan based on culture results and clinical response.
Documentation should support the medical necessity of intensive care, including the infant's age, presenting symptoms, diagnoses, interventions performed, and the physician's involvement in directing the care. Details of monitoring, treatments, and the infant's response should also be documented.
- Specialties:Neonatology, Pediatrics, Hospital Medicine
- Place of Service:Inpatient Hospital