Pediatric Coding Alert

Question: The pediatrician attends delivery (99436) for meconium staining, and there is thick meconium. Baby is AGA. When baby comes out, the pediatrician looks below the cords and suctions out some meconium. The baby has 9/9 Apgars and is fine. Can we use code 31515 (laryngoscopy direct, with or without tracheoscopy; for aspiration) in addition to the attendance at delivery? My understanding is you can only use 31515 in addition to 99440 (newborn resuscitation). But this baby did not need to be resuscitated. What do we do in this situation? It seems there is a gap in the codes. If there is meconium, the doctors always look below the cords.

Kathleen ONeill, Office Manager
Cornerstone Medical Associates
Perry, Ga.

Answer: With the scenario described above, it is appropriate to use code 99436 for the attendance at the delivery. It is not necessary to use 99440 if using 31515, although you may use both of these codes also. CPT clearly states that 31515 is for laryngoscopy, direct, with or without tracheoscopy for aspiration. It is correct to use 31515 with any of the newborn care codes. Recommended for the above scenario: (1) 31515laryngoscopy for aspiration; (2) 99436attendance at delivery; (3) 99431normal newborn care. If the child had required aspiration and resuscitation: (1) 31515laryngoscopy for aspiration and (2) 99440newborn resuscitation.

It is important that the physician document the use of a laryngoscopy for the aspiration. You may not report 99436 in addition to 99440. Please check to make sure the pediatrician documents both visualization and the aspiration done in the hospital. Documentation is also extremely important when attendance at delivery or cesarean sections are requested.