Pediatric Coding Alert

Pediatric coders often have questions about first office visits for newbornswhen the pediatrician wants to see the patients within a week of their birth, but the babies may not have any real problems. The main reason they are coming in is to be weighed.

The doctors in my office like to see a newborn, breast-feeding baby one week after discharge to assess weight gain, writes subscriber Delores S. Tully, site coordinator for Cooper River Pediatrics in Mt. Pleasant, SC. How should this be coded?

And Daniel Leviten, MD of Lakeside Pediatrics, a four-pediatrician, one-nurse practitioner practice in Lakeland, FL, wants to know: What is the appropriate code for a color check in a newborn recently discharged when no jaundice is found?

Coding these visits often hinges on whether a pediatrician from the practice saw the patient in the hospital or birthing center, and whether or not the physician sees the newborn when the baby is brought into the office.

1. Use 99211 if there is no doctor contact. We use CPT 99211 for weight checks, says Lisa Smith, office manager and president of Vidalia Pediatric Clinic, a one nurse practitioner, one pediatrician practice in Vidalia, GA. If the pediatrician doesnt see the child, this is the right code to use.

2. If the baby is seen in the hospital. This is another factor, explains Lynn Bloom, insurance administrator for Maple Avenue Pediatrics, a four-pediatrician practice in Fair Lawn, NJ. If the baby was born in the hospital were affiliated with and the pediatrician has previously examined the baby, we ask that the mom come in one week later. The baby is put in the schedule as a nurse visit, explains Bloom. If the weight gain and color are normal, the pediatrician doesnt see the baby, and there is no charge. If there are problems, then the doctor sees the baby, and the appropriate level visit is coded.

Incidentally, Bloom has also just started using 99432 for a two-week physical, done on babies the doctors have seen before.

3. If baby is not seen in the hospital. If the baby hasnt been seen in the hospital by the practiceif, for example, the baby was born at a different hospitalBloom uses 99432 for the first visit. This is much more than a weight check. The descriptor is: Normal newborn care in other than hospital or birthing room setting, including physical examination of baby and conference(s) with parent(s). It is essentially a well-baby visit, and provides a reimbursement that Lynn calls significantly higher than 99391 (well visit under 1 year).

4. Color checks. Often color checks and weight checks are done at the same time, notes Smith. The nurse does them both; if the doctor sees the [...]