Many pediatricians and payers are confused about what additional services can be billed when coding for attendance at delivery (99436, Attendance at delivery [when requested by delivering physician] and initial stabilization of newborn). If you include too many additional services, you can be accused of coding fraudulently, and if you code too few you are losing money.
Resuscitation in Addition to 99436
Some think that resuscitation code 99440 (Newborn resuscitation: provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output) includes intubation. However, that is not always the case. For neonatal resuscitation, as described by 99440, resuscitation does not automatically include intubation, although in the delivery room intubation would usually involve resuscitation.
Code 99440 involves positive pressure ventilation a bag and mask says Richard Molteni, MD, FAAP, a neonatologist and medical director of Children's Hospital and Regional Medical Center in Seattle. "This does not require an endotracheal tube," Molteni says. "If the endotracheal tube is used, it should be reported separately using 31500 (Intubation, endotracheal, emergency procedure)."
Note: Intubation in the delivery room usually means resuscitation, but it doesn't necessarily mean ongoing ventilation. Babies who are intubated and put on the ventilator are always critical care. (See coding for critical care below.)
You should use 99436 (attendance at delivery) for a newborn that does not require positive pressure ventilation or chest compression. Teri Salus, health policy specialist with the AAP division of healthcare finance and practice, says 99436 includes drying, stimulation, suctioning and blow-by oxygen. Code 99436 is for attending any delivery (whether the baby is normal or not) except one in which the pediatrician resuscitates the newborn. In that case, use the resuscitation code (99440) instead of 99436.
Proper Coding When Baby Is Critical
"When a newborn needs intubation at delivery, by definition the baby is critical," says Charles J. Schulte III, MD, FAAP, an AAP representative to the AMA CPT Codes advisory committee and practicing pediatrician in Washington, D.C.
Newborn critical care should be reported with 99295 (Initial neonatal intensive care, per day, for the evaluation and management of a critically ill neonate or infant). This can be billed in addition to the attendance at delivery (99436) or resuscitation (99440).
If you intubate a newborn, you should not code 31500 with 99295, because critical care includes intubation. However, if performed, you can report laryngoscopies (31515, Laryngoscopy, direct, with or without tracheoscopy; for aspiration; 31520, ... diagnostic, newborn) with neonatal care (99295). Based on the case, you may also bill resuscitation (99440) or attendance at delivery (99436).
