Wiki Delivery and Initial Newborn Exam

[bdeb616]

Our organization has providers that deliver newborn and then do their initial H & P exam on newborn while in the delivery room after delivery. We are unable to find verification to support either initial exam of newborn would not be separately billable due to physician already there performing a service (ie; double dipping) or that the initial newborn H & P is separately billable from the delivery.

Any help would be greatly appreciated.

Thank you

 

[nielynco]

Our organization has providers that deliver newborn and then do their initial H & P exam on newborn while in the delivery room after delivery. We are unable to find verification to support either initial exam of newborn would not be separately billable due to physician already there performing a service (ie; double dipping) or that the initial newborn H & P is separately billable from the delivery.

Any help would be greatly appreciated.

Thank you

It would depend on payer policy and then ensuring that if it is allowable by your particular payer (this service is NOT part of global OB care services per both CPT and ACOG), and the physician documents the expected work. 99460 requires a maternal and/or fetal history, examinations, ordering of diagnostic tests, meeting with the family, and documentation in the medical record. If a pediatrician is also examining the baby in the newborn nursery, both will not be able to bill this code (as it is a per day code) and while there is a code for subsequent newborn code (99462) the payer might deny one of these services billed on the same date of service despite being by different providers.

 

[bdeb616]

Thank you for your response. This help immensely.

It would depend on payer policy and then ensuring that if it is allowable by your particular payer (this service is NOT part of global OB care services per both CPT and ACOG), and the physician documents the expected work. 99460 requires a maternal and/or fetal history, examinations, ordering of diagnostic tests, meeting with the family, and documentation in the medical record. If a pediatrician is also examining the baby in the newborn nursery, both will not be able to bill this code (as it is a per day code) and while there is a code for subsequent newborn code (99462) the payer might deny one of these services billed on the same date of service despite being by different providers