Attendance @ delivery/Newborn Resuscitation

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Pediatrician attended the birth of twins delivered by C-Section that required resuscitation and stabilization @ birth before being transferred to Macon for more intensive care. She does not desire to undercut the physician that will care for the babies in Macon, however, she spent over 3 documented hours monitoring these infants in order to stabilize them before transfer. I know to bill 99440, but the reimbursement is for that code alone does not reasonably compensate her for services provided. Does anyone have any suggestions?
 

Deanne N

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Portland Metro
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Was the delivery in a birthing center or something like that? You're posting that as an additional charge to your delivery, h&P and discharge codes, right? Sorry, I work in a hospital so I'm not familiar with that situation, but you should take a look at the pediatric transport codes. You would have to make sure he documented enough to show the patient was critical (ie life threatening) and that you provide the ICD9s for that (did he document the weight, gestation? Did the baby have RDS?), but it is a time based code. Gotta love time based codes!
 
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Milwaukee WI
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Try 99477

CPT 99477 is a new code in 2008 that might cover the services provided. You would bill this in addition to 99436 and 99440.

You might also want to try 99499 Unlisted Evaluation & Management. But be prepared for a denial and for having to explain why you are billing this code and back up with documentation, documentation, documentation.

Good luck!

Tessa Bartels CPC
 
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Cpc

You won't be undercutting the work done by the physician's in Macon. I don't know if this varies by state, but we transfer babies all the time between facilities. If the baby is critical, the critical care code can be used by both groups on the same day (different tax ID number). We have not had a problem with both groups being reimbursed. If the baby was actually admitted to the NICU and not just kept in the delivery room, CPT allows both 99440 and 99295 to be used together. Some of the payers in our area want to bundle these even though CPT allows it. If the baby is not critical, but is still intensive, you can use the new code 99477.
 
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