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Question: Encounter notes indicate that the emergency department (ED) physician provided 52 minutes of critical care for a 3-year-old patient. During the encounter, the physician inserted a non-tunneled central venous catheter. Can I code separately for the catheter insertion?

Iowa Subscriber

Answer: If the patient were older, you could have reported the central venous catheter. For your patient, however, it’s a no-go.

Why? There are different codes — and a few different guidelines — when reporting critical care for younger patients. According to the Inpatient Neonatal and Pediatric Critical Care section of CPT^® 2025, the catheter insertion (36555 [Insertion of non-tunneled centrally inserted central venous catheter; younger than 5 years of age]) is bunded into the critical care service for this age group.

On the claim, report either 99475 (Initial inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 2 through 5 years of age) or 99476 (Subsequent inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 2 through 5 years of age), depending on encounter specifics.

In addition to 99475 and 99476, you would bundle the catheter insertion into the following critical care codes as well:

• 99468 (Initial inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or younger)
• 99469 (Subsequent inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or younger)
• 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)
• 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)

Exception: If, however, the patient was 6 years or older, you would use critical care codes 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and +99292 (… each additional 30 minutes (List separately in addition to code for primary service)). These codes do not include central venous access, so you would be able to report the service separately.

Do this: Check out the introductory section for Inpatient Neonatal and Pediatric Critical Care; there are services beyond those listed in 99291 and +99292 that are bundled into these codes, and CPT^® lists them here.

Chris Boucher, MS, CPC, Senior Development Editor, AAPC