TracyAlder
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Hello! I have a question about the necessary documentation needed for 99464 (Attendance at delivery (when requested by the delivering physician or other qualified health care professional) and initial stabilization of newborn). The provider I am speaking of in this instance is the neonatologist.
The provider note I received has no mention of the OB requesting the presence of a neonatologist at the birth so I denied the claim on that basis. The provider's billing office claims that the claim should be paid for the following reasons:
1. The claim form shows the OB's name in the referring section so the provider's office thinks that should prove that the OB requested the presence of the neonatologist.
2. There is an "implied request" based on the fact that the infant was admitted into the hospital shortly after birth and the decision to admit could only have come from the neonatologist.
3. The submitted records include a note signed by the neonatologist saying he was there due to the critical situation and he supervised the team, the care plan, etc. etc.
I disagree; especially about the "implied request" since I thought we're not supposed to imply or infer anything. I just don't think the documentation is adequate. Help?
The provider note I received has no mention of the OB requesting the presence of a neonatologist at the birth so I denied the claim on that basis. The provider's billing office claims that the claim should be paid for the following reasons:
1. The claim form shows the OB's name in the referring section so the provider's office thinks that should prove that the OB requested the presence of the neonatologist.
2. There is an "implied request" based on the fact that the infant was admitted into the hospital shortly after birth and the decision to admit could only have come from the neonatologist.
3. The submitted records include a note signed by the neonatologist saying he was there due to the critical situation and he supervised the team, the care plan, etc. etc.
I disagree; especially about the "implied request" since I thought we're not supposed to imply or infer anything. I just don't think the documentation is adequate. Help?