Perinatal/neonatal counseling


Sand Springs, OK
Best answers
We have a provider who is a neonatology specialist. He is, at times, called in to consult/counsel pregnant women who may be facing premature labor at less than 25 weeks, or for other issues. Oklahoma Medicaid does not cover/recognize 99401-99404. These codes are not even on their fee schedule. We have reviewed our coding books and there is not another code that appears to fit. We thought about using any of the hospital admit/subsequent codes, but he is not doing an exam of the mom. Does anyone have any suggestions for another code we could use?

Thanks in advance,

Milwaukee WI
Best answers
Counseling / Coordination of Care

The physician should document
1) total amount of time spent Face to Face with the patient
2) Amount of time which was for counseling/coordination of care (must be more than 50% of total time in #1).
3) substance of the counseling/coordination of care.

You would then code the appropriate level of E/M (consult, new patient, initial hospital visit, established patient, etc based on where patient was seen and whether your carrier accepts the consult codes) based on the time.

For example - neonatologist called to see patient who is INPATIENT in hospital ...
Called to see Ms Patient due to concerns for possible premature birth. Total time spent with patient 30 minutes, 100% spent in counseling/coorindation of care. Discussed neonatology concerns for an infant born at X weeks gestation, including possibility of transfer to XYC hospital for neonatal intensive care.
If your carrier accepts consult codes you would code 99253. If your carrier does NOT accept consult codes and this was your first inpatient encounter with her, you would use CPT 99221.

Hope that helps.

F Tessa Bartels, CPC, CEMC