Pediatric Coding Alert

Most pediatricians go to the hospital once or, maybe, twice a day for rounds. If the provider goes to the newborn nursery in the morning, and a baby is born after he or she leaves, that baby usually wont be seen until the next day. Some pediatricians wonder if they can bill the admission code for that first day, even though they dont see their patient.

The admission code for a normal newborn is 99431. The descriptor for this code is: history and examination of the normal newborn infant, initiation of diagnostic and treatment programs and preparation of hospital records.

This sounds simple enough. The admission code should be used on the initial examination of the patient. But, practice managers note, the pediatrician is responsible for the care of the baby from the moment he or she is born. Should they be held responsible for the care of a patient they havent seen yet and cant bill for?

The physician is responsible for that newborn and has left appropriate orders for a newborn, explains Lucy Everett, office manager for Southeastern Pediatric Associates, a four-pediatrician practice in Dothan, AL. However, there may not be the hands-on physician exam until the next day, at which time your admission history and physical examination is dated differently from the actual date of birth.

Everetts physicians round in the newborn nursery twice a day, in the early morning and evening. If a baby is born after evening rounds, that newborn is not physically seen and examined by a physician until the next morning, unless there are complications and it is necessary to attend to the baby, she adds. The question among our physicians is, what date do you code for 99431the actual date of birth, or the first date seen and examined by the physician?

The answer is, you cannot code 99431 without seeing the patient, regardless of the fact that this means you may be liable for that baby for a day without getting any money for that day. In order to use an evaluation and management code you must do everything for that code to document it for that day, says Richard H. Tuck, MD, FAAP, a coding trainer with the American Academy of Pediatrics (AAP). 99431 requires a history and examination, he says.

Everetts practice is actually in a less precarious situation because their pediatricians round twice a day. Many pediatricians only round once, meaning that their liability is quite extended. For these pediatricians, if a baby is born at 10:00 a.m., after morning rounds, they will be responsible for that child until the next morning, when they will finally see the baby and finally be able to charge.

The alternative is to round more often, says Tuck.