Pediatric Coding Alert

Reader Question:

99464 Isn't Billable for Missed Deliveries

Question: Prior to delivery, an obstetrician asked that one of our pediatricians be present for a high risk delivery. How should we code the exam when the pediatrician arrives just after the baby's birth?Florida SubscriberAnswer: If the pediatrician was in attendance at the delivery, report 99464 (Attendance at delivery [when requested by the delivering physician] and initial stabilization of newborn). If your physician was not in attendance at the delivery -- whether she missed it by seconds or hours -- you cannot code 99464. Instead, you should use 99460 (Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant).Tip: When dealing with these types of cases, keep three things in mind: You must have a physician request for the pediatrician's service; the service must be medically necessary; and you can only report 99464 if the pediatrician is present at delivery.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.