Coding for Critically Ill Newborns Who Are Transported
Published on Thu Jul 01, 1999
When a newborn requires certain procedures to be performed by the pediatrician who is at the delivery, but then the newborn is transported to another facility, how should the pediatrician bill for the time involved? Georgia Greenhill, from the office of Susan B. Chamberlain, MD, a pediatrician in Trenton, MI, has been having problems getting reimbursed for all of the procedures done in such cases. The following scenario is typical: Chamberlain attended an emergency c-section for an abrupted placenta. She performed resuscitation with positive pressure breathing, endotracheal intubation, and laryngoscopy for aspiration. She then spent an hour attending the baby, waiting for the transport team to arrive. Blue Cross wont pay for all of the procedures, says Greenhill.
Stabilization vs. Attendance
Most insurance companies will not pay for each of these procedures separately, so billing for the encounter is a matter of choosing the best-paying combination of codes, explains Donelle Holle, RN, reimbursement specialist for the Department of Pediatrics at the University of Michigan Health System. If you are attending a delivery and doing a resuscitation, then you need to look at reimbursement, she says. For attendance at delivery and resuscitation, you can only use one code, she explains.
Attendance at delivery is code 99436 (attendance at delivery [when requested by delivering physician] and initial stabilization of newborn), which is to be used when the obstetrician requests the pediatrician to be present. Since 99436 is also for initial stabilization of newborn, resuscitation is considered bundled into the attendance-at-delivery code, says Holle. However, newborn resuscitation would be the best code to use in Chamberlains scenario. But in order to use 99440 (newborn resuscitation: provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output), you must provide either positive pressure ventilation, chest compressions, or both. You cant bill both 99436 and 99440, says Holle. CPT Codes even states that 99436 may not be reported in addition to 99440.
Noting that carriers pay better for 99440 than for 99436, Holle says that when positive pressure breathing or chest compressions are required, the pediatrician should definitely code 99440 and not 99436.
But many newborns are resuscitated by positive pressure ventilation only. And 99440 doesnt cover endotracheal intubation; it covers positive pressure ventilation and/or chest compressions. The ET tube is not bundled into the procedure.
Coding for Other Procedures
What about the other procedures done by Chamberlainpositive pressure ventilation (94652, with or without nebulized medication), endotracheal intubation (31500, emergency procedure), and laryngoscopy for aspiration (31515, with or without tracheoscopy)? The only one of these [...]
