Wiki 99381 not covered in hospital setting?

[mpar3ker]

I am recently billing for a Peds Dr. and I have found that when billing a 99460, 99462 & 99381 insurance is no longer covering the 99381 due to the POS; hospital. (They originally were). I had looked in the CPT and suggested that the 99238 or 99239 be used for the discharge date, but was told by billing staff insurance denies those also. I try to make sure to have the EPSDT attached to the ailment of the claim when it's sent out and I'm confused on what to do because the provider is telling me that she can do those exams that early and it should be covered. I'm at a loss here.
Any information as to why the 99381 isn't covered in the hospital setting...or how to correctly code the discharge of the infant from the hospital? I would be very greatful for any responses.. Thanks in advance.

 

[mitchellde]

You would not bill a preventive medicine code in the inpatient setting once you have billed for the initial newborn encounter. For the discharge you use the 99238, 99239 codes.

 

[ahonkomp]

I have never heard of billing the phys codes (99381 or 99391) for the discharge. CPT book indicates to use them AFTER the date of discharge in the office or outpatient setting. You should be using 99238-99239 for the date of discharge. 99381 would be inappropriate anyways because they wouldn't be a "new" patient on the 3rd day. Maybe your discharge codes needs a modifier if they had a circumcision? We put a 24 on the discharge code if they had a circ prior to discharge day. Hope this helps!