Wiki HIV+ mom/coding for newborn

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Lisa Bledsoe

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I'm not sure what to tell my doc on this one. She spent 2 hours prior to delivery consulting with the OB and infectious medicine docs and parents for impending delivery preparation, etc for newborn - mom is HIV+. She wants to code for this time (it was apprx 10pm-12am). Delivery did not occur until apprx 1am in the morning. She wants to code 99356 and 99357, but of course that isn't possible since there is no E/M to attach them to, and they are not billable with 99464. I think she is stuck with just 99464 (not that it will matter since it's a Medicaid patient...but the docs in my practice are paid by the practice based on provided services, not actual reimbursement). Any suggestions are greatly appreciated!!! :confused: :eek:
 
Stumped

Lisa,
I'm not sure she can code anything to capture the extra work of this "consultation."

Her patient is the baby, who wasn't born yet, so there isn't any E/M you can provide to him/her the day before s/he is born.

It doesn't sound like she was consulting with the mother regarding options (our surgeons do that for cases where US has shown an oomphalocele for example). If she were doing that, you would bill the appropriate consultation code with the mother as patient.

It doesn't seem fair, but I think all she can get is 99464 - and since that code has no time associated with it you can't add the prolonged service codes.

You might want to consider the 99499 Unlisted E/M ... but again ... who is the patient? You can't submit anything for the baby as patient on the date before the baby is born.

Sorry I couldn't be more help.

F Tessa Bartels, CPC, CEMC
 
Thanks Tessa - you confirmed what I already thought - 99464 is probably all she can get. This mom was planning a home birth with a midwife and ended up in the hospital because she had ruptured membranes for more than 24 hours without delivery. One of our OB's took care of mom, and one of our peds got the newborn.
 
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