Pediatric Coding Alert

4 Vignettes pin down initial newborn care differences Initial newborn care codes pay from a high of $868 to a low of $60. Over- or under-charging accusations won't haunt you if you code based on these guidelines. Use 99477 for Really Sick Newborn Take advantage of new code 99477 when a noncritically ill baby requires intensive care services on delivery, the initial assessment day or readmission within 28 days. Example 1: A pediatrician performs an initial assessment of a newborn and finds the baby has tachypnea (770.6) that requires oxygen, interval checks and monitoring. The E/M service involves work-up for possible sepsis. The physician admits the newborn from the delivery room to the intensive care unit (ICU). Old way: In 2007, you would have to code this E/M as level-three initial hospital care (99223, Initial hospital care, per day, for the evaluation and management of a patient ...), which pays approximately $174 (4.96 relative value units [RVUs]) using the 2007 Medicare Physician Fee Schedule. Before 99477's creation, when a baby doesn't meet critical care requirements (99295, such as organ system failure) but needs a level of care beyond the acute admissions codes, "we default to a code that has a lesser value than the service being provided," notes Sheryl Forrester, CPC, at Children's University Medical Group in Seattle. "We are trying to apply adult codes and guidelines to these infants, and the coding and documentation requirements don't fit." New way: On claims dated Jan. 1, 2008, and later, you'll be able to use 99477 (Initial hospital care, per day, for the evaluation and management of the neonate, 28 days of age or less, who requires intensive observation, frequent interventions, and other intensive care services) instead of 99223. "I appreciate all of the effort being put in to creating codes that better describe the work" my doctors perform with appropriate values, Forrester says. Payment: CMS recognized the extra work 99477 represents and assigned it 9.30 RVUs (7 work units) for 2008. Using the 2007 conversion factor, 99477 would pay $352. That's $178 more than 99223 pays and $516 less than 99295 pays (approximately $868 for 24.59 RVUs). Report Involved Work-Up With 99222-99223 When a newborn's condition doesn't require 99477's intensive care services, but still necessitates hospital E/M services, look to 99222-99223. Example 2: After a pediatrician performs normal newborn care, the infant has a feeding problem that necessitates another E/M service on the same day. An x-ray is normal, and no further interventions are required. This scenario would require an E/M service that would warrant a mid- or upper-level initial hospital care code, says Richard H. Tuck, MD, FAAP, a pediatrician at PrimeCare of Southeastern Ohio in Zanesville. Because the newborn's [...]