Wiki Billing a newborn's first outpatient visit

[JanaiJenkins]

Hello,

I am newly certified (as of December 2022) and six months into my role as a biller for a private pediatric practice. I would like to know from other more experienced billers/coders how your practice bills a newborn's very first visit. Do you bill it as a well check/preventative visit or an office/sick visit? For context, I am only referring to generally healthy babies (i.e. babies that were not diagnosed with health challenges in the hospital). My practice has been doing things a certain way long before I arrived, and I have questions and concerns about it. Any information and input are greatly appreciated. Thank you.

 

[skrol210]

We bill our newborns first visit a 99381 (new patient preventative visit)

 

[KGETGEN]

We bill our newborns first visit (3day-5day old) as a new patient office visit. Our providers check weight and jaundice at these visits. We bill this way because we see the neonate at either a 1wk and/or 2wk visit which is billed as preventive. The insurances that our office participates with only cover 6 well visits before 12mo of age. We have encountered where other offices in the area will bill EVERY weight check visit as a preventive visit and when the baby transfers to our office at 6 months, their benefits are exhausted and parents end up with a bill or we have to write it off depending on insurance.