Pediatric Coding Alert

A newborn's condition can change from normal to sick to normal again before the infant leaves the hospital. Accurately coding these transitions in the health of neonates depends on carefully monitoring and reporting the progression of services a pediatrician provides for the neonate until the patient is ready to go home. Normal Newborn Stays Well:Report Newborn Care Codes If, after examining a newborn in the hospital nursery, the pediatrician determines that the baby is normal, you should report 99431 (History and examination of the normal newborn infant, initiation of diagnostic and treatment programs and preparation of hospital records [this code should also be used for birthing room deliveries]) for the initial examination, according to CPT.

For each subsequent day the physician provides care for the normal neonate in the hospital, assign 99433 (Subsequent hospital care, for the evaluation and management of a normal newborn, per day). Because 99431 and 99433 are per-day codes, you may bill them once per day only, regardless of how often the pediatrician sees the infant, coding experts stress. CPT Codes also specifies that when the physician admits and discharges the neonate from the hospital or birthing room on the same day, you should use 99435 (History and examination of the normal newborn infant, including the preparation of medical records [this code should only be used for newborns assessed and discharged from the hospital or birthing room on the same date.])

Moreover, code 99435 also applies to same-day initial examinations and discharges when a baby delivers at night and the pediatrician initially examines it the next morning and discharges that evening.

If the physician discharges the newborn on a subsequent day after it is admitted, CPT states that you should report 99238 (Hospital discharge day management; 30 minutes or less) when the discharge services, such as giving instructions for care, take 30 minutes or less to complete.

If discharge services take 30 minutes or longer, such as when an infant has been ill and the doctor spends extra time coordinating care or when an anxious mother with many questions requires extra time, report 99239 ( more than 30 minutes), says Richard Tuck, MD, FAAP, practicing pediatrician with Primecare Pediatrics of Zanesville, Ohio. These discharge codes are day codes and apply to all services performed on that day. Because these are also time-based, document the time spent in the patient's record if greater than 30 minutes, Tuck says. Well Newborn Gets Sick:Report Hospital Care Codes Often, a newborn will appear normal at birth but will develop a problem such as jaundice (774.6), tachypnea (770.6), or polycythemia (776.4) a few hours later [...]