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Definition of Normal Newborn

M

MCCONKEYT

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38
Location
Florissant, Colorado
I have been assigned to audit a Pediatrics practice for 99460 - 99463 & 99477 - 99480. I would like to know where to find the guidelines for what is considered a normal newborn.
Any help would be appreciated.
 
The doctor used 99460, Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant. But the newborn was born with cleft lip and palate. Of course, there were feeding problems. To me, that doesn't seem "normal." I need documentation to back myself up with.
 
Generally Speaking...

:cool:

Typically, a normal newborn has no medical conditions or need for special care. The ICD-9 code ought to be only V30.xx. Generally speaking, if one needs to add another ICD-9 prior to the newborn being discharged, then this does not qualify as "normal" newborn.

The CPT book guides you towards other E/M services for NOT normal newborns.

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So, based on what you have stated, I would agree with you, that this does not qualify as "normal newborn". Be sure to check your state laws about this, as some may differ.
 
Normal newborn

It is important to remember that the CPT code represents physician work. If documentation supports physician work beyond what is typical for a normal newborn, it would be appropriate to suggest a level of E/M service supported by the documentation.
 
So, if they are not critically ill, which rules out 99468-99469, I'm not sure 99477, "requires intensive observation, frequent intervention and other intensive care services," is the appropriate code either.

I am thinking that perhaps 99221 is the correct code per the guidelines, "E/M services provided to newborns who are other than normal, see codes for hospital inpt. services
(99221-99233) and neonatal intensive and critical care services (99466 - 99469, 99477 - 99480)."

What is throwing me is the "normal" wording. What exactly does that word emcompass?
 
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