Wiki Cpt 99464

[jwhitmorecpc]

I am a professional coder for a small community hospital and it is their policy that a pediatrician has to attend all c-sections. It does not matter if the c-section is emergent or non-emergent (i.e. repeat). The billing office is questioning about charging CPT 99464 for the attendance of this pediatrician. I am reluctant, because the documentation has to support medical necessity for this code. The pediatrician takes the infant and assesses after the delivery, so there is a service being rendered at that time. Would that service be included in CPT 99460? Is there a CPT code that can be charged in lieu of CPT 99464 if medical necessity is not supported? If the pediatrician is required to be in attendance, there should be a charge for their time. Thank you for your help.

 

[bwolfe1]

Look at 99360 and be sure to read the notes following.

 

[Emmy1260]

We have the same policy at my hospital. I post both the attendance 99464 and the newborn exam 99460 for the physician. We have not had any denials.

For a vaginal delivery, there would need to be some documented reason for attending delivery, i.e. fetal distress. A c-section carries more risk to both the mother and child, i.e. use of anesthesia, that would justify having a pediatrician available at delivery in case of complications.