Here are some key guidelines for NICU billing

When billing room and board services for pediatric patients outside of the defined newborn age of 28 days or less for new admissions, health care providers should use the appropriate corresponding pediatric room and board revenue codes. 

According to ICD-10-CM classification guidelines, a newborn is defined as a baby who is in the first 28 days of life. Critical care services for the newborn take place in a nursery or neonatal intensive care unit, also called NICU, and are represented by revenue codes 0170-0174. If a medical condition presents after the first 28 days of life, it’s no longer considered a newborn medical condition.

Exclusions to this billing guideline are when the patient is transferred from the birth hospital to another hospital for non-routine care, with services beginning during the newborn period.

Newborn and pediatric revenue codes and descriptions:

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with all applicable state and federal laws and regulations.