Wiki Is it appropriate to bill 99356 in conjunction with 99464?

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Coral Denham

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I have a question I am hoping someone can help me with. One of our pediatricians was in attendance for the delivery of a high-risk cesarean child. We are billing 99464 (Attendance at delivery and initial stabilization of newborn) for the attendance, however he also spent 30 minutes waiting in addition to attending the delivery. The code for standy, 99360 (Physician standby service, requiring prolonged physician attendance), cannot be billed in conjunction with 99464. Our physician is wondering if it would be appropriate to bill 99356 (Prolonged physician service in the inpatient setting) for his time. It appears that might not be allowable because there was no face to face contact during the waiting time.

If it is not allowable to bill 99356 would he just be unable to bill for his standby time, or is there a different CPT code he could bill?

I appreciate your help in this matter.

Coral
 
After looking at this case I would code it using 99468 Initial inpatient neonatal critical care. The reason is this can be used in addition to 99464 which states the physician is present for delivery. Let me know if this helped and was proper.
 
But remember, you cannot bill critical care if it is not stated in the record that the baby is critical and why. If he DOES say this, it is a much better paying code. If not, you have to go with 99464.
Either way, he cannot use prolonged services, because those are not time based codes, and he cannot use standby codes.
30 minutes to wait for a baby isn't much! I coded one where the doc waited 4 hours.
 
Standby time NOT prolonged

Another reason you cannot use the prolonged service code is that the pediatrician was not directly attending to his patient (the neonate) during the time s/he was waiting for the birth.

From the limited info you give I would not use 99468 either. This is a code that can only be used ONCE per day ... IF the child was critically ill and required the NICU, most likely the neonatologist will be using that code.

If the infant was not critically ill, but required intensive monitoring ... AND there is no separate neonatologist running the NICU who will use the code ... you pediatrician might be able to use 99477.

Of course, all this depends on what is actually documented.

Hope that helps.
F Tessa Bartels, CPC, CEMC
 
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Agreed. I think I was assuming she was coding for the neonatalogist (or whoever would be the attending for the baby), and looking back, she probably isn't.
 
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