Medicaid Denials - Newborn Daily Visits

LeaHarris

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It appears that my office is receiving denials for CPT code 99462 & 99239 when matched with ICD-10 Z00.110 (health check for newborn under 8 days). Does anyone have another diagnosis that might be more appropriate?
 

CodingKing

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Are you sure its the DX that's causing the denial or is there a limit on the number of visits allowed for a well baby in the hospital. I've worked for carriers that only pay for 1 newborn E&M for a well baby. If its the delivering physician that could be an issue as well as there are some bundling issues.
 
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newborn hospital visits

You might check to see if the payer wants a Z38 code for visits during the birth admission. The guidelines support this, "When coding the birth episode in a newborn record, assign a code from category Z38, Liveborn infants according to place of birth and type of delivery, as the principal diagnosis."
 

gigiduffy

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Subsequent Days - newborns in hospital

This issue is screaming at me - the CPT manual stats that the Z38 code is to be used only on the initial birth record. Are subsequent visits considered to be part of the birth record since they are part of the same hospital confinement? If I use the Z00.110 for the subsequent days visits or the discharge visit on a 99460 or the discharge code, is this more correct. The initial birth record verbiage in the CPT book is what is throwing me for a loop. Any assistance would be greatly appreciated. I may have raised a red flag on this for nothing, and I do not want to have egg on my face.
 
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Jeffersonville, Indiana
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Z38 series vs. Z00 series coding for Inpatient Newborn Visits at the Birth Hospital

I, too, was struggling with this issue, until I found this topic in an American Academy of Pediatrics (AAP) Q&A article:

You will always report a code from Category Z38 as primary when the baby is staying in the birth hospital from birth. Once the baby is discharged, you will never report the Z38 code again.
Be sure to report Z38 as the primary code for each day the baby is in the birth hospital from birth, The guideline regarding Z38 being reported only once at the time of birth has confused people. The intent was that it is used only once for the entire birth stay at the hospital of birth. Do not report a code from category Z00 for the baby’s stay in the hospital.

That was a direct excerpt from AAP News Volume 36, Number 8, August 2015.

I hope it helps!!!
 

danielle0419

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Our practice uses Z38.00,Z38.01,Z38.30,Z38.31 as primary dx for these codes while the newborn is in the hospital. Any other problems of the newborn would be secondary. You would only use WCC dx once they are out of the hospital in the Providers office.
 
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for our practice at Florida 99462 & 99239 is been denied even after linking to diagnosis Z38.00. Only cpt paid is 99460 with Z38.00. please help.
 
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