Pediatric Coding Alert

Question: When our neonatologist is called in for a prenatal consultation on a high-risk birth, do the regular consultation codes apply?

Julia Bellew, medical chart auditor
Optimum Physician Services, Greenville, S.C.

Answer: Absolutely. These visits should be billed as normal hospital consult codes (99251-99255) with counseling defining the majority of the service (E/M documentation guidelines for history and physical and complexity of medical decision-making are not attained in these visits), so that the level of coding is based on time. You cannot use time as a factor in choosing a level unless counseling takes up 50 percent or more of the time spent in the encounter. As with any consult, you should note that this was requested by the obstetric provider, and send him or her a written copy of the consult. The new consult guidelines from Medicare do not require a written request. Note that the consultation is on the mother.


Answers to Reader Questions and You Be the Coder contributed by: A.D. Jacobson, MD, FAAP, member, American Academy of Pediatrics Coding and Reimbursement Committee; Richard H. Tuck, MD, FAAP, member, American Academy of Pediatrics Coding and Reimbursement Committee; Richard A. Molteni, MD, FAAP, member, CPT Editorial Panel; and Victoria Jackson, chairwoman, Pediatric Task Force Committee, Medical Group Management Association.