Pediatric Coding Alert

Tip: Separate site warrants separate pay If you don't know the exceptions to the critical care bundles, you could be under-reporting neonatal services and procedures.

Test yourself by coding this scenario submitted by Pamela J. Dirickson, coder with Neonatology Cox Health in Springfield, Mo.:

A doctor attended a delivery of a 28-week gestation baby. The infant received positive pressure ventilation (PPV) in the delivery room (DR) with mask and bag for absent respiratory effort at birth. The baby was then intubated in the delivery room and received PPV on transfer to the neonatal intensive care unit (NICU) where mechanical ventilation was initiated.

"Can we charge 99440 (Newborn resuscitation: provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output) for the resuscitation in the delivery room and 31500 intubation in the delivery room as well as 99295 (Initial inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or less) for the admit to the NICU?" she asks.

"I have received advice that would have me use modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service), 51 (Multiple procedures), and/or 59 (Distinct procedural service) with these charges. What is the correct billing at this time?"

Use these steps to determine what codes to bill in addition to 99295. 1. Bill 99436/99440 Separately From 99295 When coding resuscitation with initial neonatal critical care, you should always remember one rule: "Newborn resuscitation services (99440) may be reported in addition to 99295," says Darlene Ornburn, MBA, CPC, CCP, in her presentation "Taking the Crisis Out of Critical Care Coding." That means, in the above scenario, as well as anytime a pediatrician attends a delivery and provides resuscitation, you should report both 99440 and 99295.

Be careful: Although the pediatrician attends the delivery, you should not also report that service. "Do not report 99436 in conjunction with 99440," according to CPT's parenthetical instruction following 99436.

Modifier: No bundle exists for 99440 and 99295. In 2004, CMS deleted the code edit for 99440 and 99295. Therefore, no modifier should be necessary when reporting this pair. The Georgia Chapter of the American Academy of Pediatrics lists 99440 (newborn resuscitation) with 99295 as "examples of services performed on the same date of service that do not require a modifier."

Similarly, you may report 99436 (attendance at delivery) with 99295 (initial inpatient neonatal critical care) or 99431 (initial normal newborn care) without a modifier. Some insurers, however, may want modifier 25 on 99295 to indicate the critical care -- or on 99431 to indicate the initial newborn care -- is a significant, separately identifiable [...]