Pediatric Coding Alert

Question: How should I bill for attending delivery of a baby if the on-call pediatrician was paged in error and the family pediatrician does rounds at the hospital? Our pediatrician attended a delivery for meconium and suctioned the baby, who was hypotonic and poorly perfused. He spent 90 minutes getting the baby fluids. He then spoke to the father, who said the family already has a pediatrician with privileges at the hospital (the nurse made a mistake).

Oregon Subscriber

Answer: Your pediatrician can bill for the work he did. Although the family already has a pediatrician, if that pediatrician did not attend the delivery or admit the baby, then he or she cannot bill. But your pediatrician did, and he may code 99436 (attendance at delivery [when requested by delivering physician] and initial stabilization of newborn) and a hospital admission (99222 or 99223). Do not code 99431 (normal newborn admission): This baby is not a normal newborn. If you provided resuscitation, you can bill 99440 (newborn resuscitation: provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output). You cannot, however, bill 99440 in addition to 99436. If the pediatrician intubated the baby to suction him, code 31500 (intubation, endotracheal, emergency procedure) also.