Pediatric Coding Alert
Reader Question:
Consult or Initial Hospital Care? Choose One
Published on Mon Jun 17, 2013
Question: Our neonatologist was called to a consult (99251) and then determined the baby needed to be admitted to the NICU. Can we bill for both the consult and the admit (99477), or do we have to choose one?
Colorado subscriber
Answer: Most insurers will not allow you to report both the consultation and the admit, and most coding guidelines do not support coding this way. Instead, the work your doctor performed during the consult will be included in the “per day” payment for the initial hospital care code. Therefore, you’ll report 99477 (Initial hospital care, per day, for the evaluation and management of the neonate, 28 days of age or younger…).
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