Pediatric Coding Alert

Question: Recently, our pediatrician was called to the hospital for a scheduled cesarean section delivery. He was there for about 30 minutes, but left after the mom changed her mind. Two hours later, he went back to examine the baby for fetal distress and stayed to attend the delivery when the surgeon decided to go ahead with the cesarean section. He examined the newborn right after the delivery and for the next two days before he discharged baby and mom without recording any problems. How do we code this scenario?

Oregon Subscriber

Answer: Begin by documenting 99464 (Attendance at delivery [when requested by the delivering physician or other qualified health care professional] and initial stabilization of newborn) for the delivery, adding 99460 (Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant) for the initial well-newborn evaluation.

Note that once you report 99464, you cannot code for 99360 (Standby service, requiring prolonged attendance, each 30 minutes [eg, operative standby, standby for frozen section, for cesarean/high risk delivery, for monitoring EEG]), as CPT^® guidelines prohibit reporting the two codes together. You may, however, report 99360 with 99460 if your provider does not attend the birth.

Also, although it is not specifically stated in the CPT^® guidelines, you may have to attach modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service) to 99460 depending on payer guidelines. As always, check with your payer before submitting your claim.

Coding alert: Remember, 99460 is for a healthy newborn. So, you would only use 99460 for the initial newborn visit if the neonate has no complications or requires no further evaluation.

Finally, you would use 99462 (Subsequent hospital care, per day, for evaluation and management of normal newborn) for the examination the following day and 99238 (Hospital discharge day management, 30 minutes or less) or 99239 (Hospital discharge day management; more than 30 minutes) for the discharge, depending on the length of time your physician spent with the newborn on discharge day.