Pediatric Coding Alert

Question: I'm coding for a newborn who was normal for the first two days and developed tachypnea on the third day. How do we code the shift in status?

Louisiana Subscriber

Answer: If you're coding a continuous hospital stay, switch to the subsequent hospital visit codes for the third day (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient ...).

Your coding changes if the infant went home and returned with the problem. In that case, start with an initial hospital visit (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient ...) or initial observation code (99218-99220, Initial observation care, per day, for the evaluation and management of a patient ...), depending on the patient's status and the provider's documentation.

Starting point: Your coding for the newborn's first two days remains the same. Submit 99460 (Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant) for day one and 99462 (Subsequent hospital care, per day, for evaluation and management of normal newborn) for day two.