How would you guys interpret this rule? Our county Medi-Cal program is denying a 99460 billed with a discharge 99238 on the next day because the same doctor is providing the initial newborn service, and discharging the next day. Makes NO sense to me why it would matter that it's the same doctor?? They are citing this rule as the reason..
• CPT-4 codes 96110 (developmental screening, with scoring and documentation, per standardized instrument), 96111 (developmental testing, with interpretation and report) and
99238 and 99239 (hospital discharge day management) are not reimbursable if billed within one month of code 99460 or 99462 (normal newborn care services) by the same provider for the same recipient.
I take that as billing the screening plus discharge, in the same month as the 99460/99462, not JUST billing a discharge. It's driving me crazy to be honest.
• CPT-4 codes 96110 (developmental screening, with scoring and documentation, per standardized instrument), 96111 (developmental testing, with interpretation and report) and
99238 and 99239 (hospital discharge day management) are not reimbursable if billed within one month of code 99460 or 99462 (normal newborn care services) by the same provider for the same recipient.
I take that as billing the screening plus discharge, in the same month as the 99460/99462, not JUST billing a discharge. It's driving me crazy to be honest.