Pediatric Coding Alert

How much have you learned about three critical aspects of coding for newborns whose condition changes before they're discharged? Take the following short quiz, and then look in the box below  to check your answers against those provided by coding experts. 1. If a well newborn develops a noncritical problem soon after birth, should you report both the normal history and examination code (99431) and the appropriate initial hospital care codes (99221-99223)? 2. Acritically ill newborn improves while in the neonatal intensive care unit (NICU) and is no longer critical. Should you report hospital care codes, even though the infant is still in the NICU? 3. What's the best way to code this situation: Anon-critical very low birth-weight neonate (weight less than 1,500 grams) develops breathing problems and requires reintubation, becoming critical again.

1. When a neonate develops a problem, it is no longer "normal." Consequently, you would report the initial hospital care (99221-99223) not normal history and examination (99431) for the first day. After the first day, report the subsequent hospital care codes (99231-99233) for each day the newborn receives care for the condition.

2. Yes. A neonate who is no longer critically ill may still be in the NICU, but because the infant no longer requires such interventions as a ventilator to help it breathe, it may not qualify for newborn critical care codes (99295-99296). Instead, report the appropriate subsequent hospital care code (99231-99233). 3. Many babies who qualify for 99298 ( very low birth weight infant [present body weight less than 1500 grams]) "graduate" to the corresponding code from the neonatal critical care codes (99296). Some will go back and forth between 99298 and 99296 if, for example, they require reintubation. You should report 99296 for each day the infant receives critical care services and 99298 for each day the infant is less than 1,500 grams and is receiving neonatal intensive care.