AAPC Certified Professional Coder (CPC) — Question 116

A 4-year-old, critically ill child is admitted to the PICU from the ED with respiratory failure due to an exacerbation of asthma not manageable in the ER. The PICU provider takes over the care of the patient and starts continuous bronchodilator therapy and pharmacologic support with cardiovascular monitoring and possible mechanical ventilation support.
What is the E/M code for this encounter?

Answer options

• A. 99285
• B. 99475
• C. 99291
• D. 99471

Correct answer: B

Explanation

The correct code is 99475, which is specifically designated for critically ill patients under 28 days old or those admitted to a PICU. Code 99285 is for emergency department visits with high severity, 99291 is for critical care services, and 99471 is for pediatric critical care consultations, but they do not accurately reflect the scenario of a PICU admission for this age group.