Practice Management Alert

Question: My physician was the primary care physician for a baby who was born to a mother who was addicted to drugs. She was on methadone, and as a result the baby had to stay in the hospital for five weeks on a withdrawal program. How should we bill for the 42-day daily inpatient check my doctor performed?

Oregon Subscriber

Answer: You should bill each day's care using two sets of codes: one for the newborn care (through the 28th day) and one for the infant care (29th day through the 41st day).

If the newborn, especially in the early period, required intensive observation and frequent interventions, you should code Initial and Continuing Intensive Care Services (99477-99480) on days 1-28. On day 1, you would use 99477 (Initial hospital care, for the evaluation and management of the neonate, 28 days of age or less, who requires intensive observation, frequent interventions, and other intensive care services).

Then, for days 2 though 28, choose the code based on the newborn's daily weight. You will probably use 99479 (Subsequent intensive care, per day, for the evaluation and management of the recovering low birth weight infant [present body weight of 1500-2500 grams]) and 99480 (Subsequent intensive care, per day, for the evaluation and management of the recovering infant [present body weight of 2501-5000 grams]).

For days 29 through 41, you'll assign the appropriate  level of subsequent hospital care (99231-99233,Subsequent hospital care, per day, for the evaluation and management of a patient ...). Report the discharge with 99238 (Hospital discharge day management; 30 minutes or less) or 99239 (... more than 30 minutes).

ICD-9 includes a newborn and infant code for withdrawal: 779.5 (Drug withdrawal syndrome in newborn). "Drug withdrawal syndrome in infant of dependent mother" also falls under 779.5.