Primary Care Coding Alert

4 vignettes pin down when to report 99477 Initial newborn care codes pay from a high of $978 to a low of $60. Over- or undercharging accusations won't haunt you if you code based on these guidelines. Use 99477 for Really Sick Newborn Take advantage of new code 99477 when a noncritically ill baby requires intensive care services on delivery, the initial assessment day or readmission within 28 days. Example 1: An FP performs an initial assessment of a newborn and finds the baby has tachypnea (770.6) that requires oxygen, interval checks and monitoring. The E/M service involves workup for possible sepsis. The physician admits the newborn from the delivery room to the intensive care unit (ICU). Old way: In 2007, you had to code this E/M as level-three initial hospital care (99223, Initial hospital care, per day, for the evaluation and management of a patient -), which pays about $197 (4.96 relative value units [RVUs]) using the 2008 Medicare Physician Fee Schedule. Before 99477's creation, when a baby doesn't meet critical care requirements (99295, such as organ system failure) but needs a level of care beyond the acute admissions codes, "we default to a code that has a lesser value than the service being provided," says Sheryl Forrester, CPC, at Children's University Medical Group in Seattle. "We are trying to apply adult codes and guidelines to these infants, and the coding and documentation requirements don't fit." New way: On claims dated Jan. 1, 2008, and later, you-ll be able to use 99477 (Initial hospital care, per day, 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) instead of 99223. "I appreciate all of the effort being put in to creating codes that better describe the work my doctors perform with appropriate values," Forrester says. Payment: CMS recognized the extra work 99477 represents and assigned it 9.30 RVUs (7.00 work RVUs) for 2008. Using the 2007 conversion factor, 99477 would pay about $370. That is $173 more than 99223 pays and $608 less than 99295 pays (about $978 for 24.59 RVUs). Involved Workup Calls for 99221-99223 When a newborn's condition doesn't require 99477's intensive care services but still necessitates hospital E/M services, look to 99221-99223. Example 2: After an FP performs normal newborn care, the infant has a feeding problem that necessitates another E/M service on the same day. An x-ray is normal, and no further interventions are required. This scenario would require an E/M service that warrants a mid- or upper-level initial hospital care code, says Richard H. Tuck, MD, FAAP, a pediatrician at PrimeCare of Southeastern Ohio in Zanesville. Because the newborn's [...]