Pediatric Coding Alert

We have learned that some pediatric practices are using 99432 for office visits of newborns during the first month. This code is for normal newborn care in other than hospital or birthing-room setting. This is a newborn care code, and pays more than the well-baby visit code 99391 (periodic preventive medicine, age under 1 year). Nothing in CPT actually states that 99432 is for initial care only, although that is certainly implied. We asked Richard A. Molteni, MD, FAAP, medical director of Childrens Hospital and Regional Medical Center in Seattle, and a member of the CPT editorial panel whether it is proper to use 99432 for a three-day or two-week office visit. He says, most emphatically, that it is not.

The 99432 code was not designed for office visits of newborns, says Molteni. If it had been, we would have been coding all visits in infants less than one month of age with the newborn codes. What 99432 is designed for is travel to a home or a birthing center or midwifery center to see a baby, says Molteni. It is not meant to be a routine office visit, much less a follow-up office visit (in most cases, the pediatrician has already seen the baby in the hospital).

This is incorrect coding, and its based on the push for early discharge, adds Molteni. Pediatricians used to bill for each of the three or four hospital days a baby was there. But now, many health plans require discharge 48 hours after delivery. The result is that when the baby is seen in the office three days or two weeks after discharge, the intensity of the visit has increased, says Molteni. This means these visits should be valued higher in terms of RVUs, he says. But they are still office, not hospital, visits, and should be coded as such.

Tip: Dont use the preventive medicine codes for the three-day visit. Instead, use an office visit code with V29.8 (observation for other specified suspected condition) as the diagnosis code, if the patient is normal.