68. A neonate was born at 36 weeks gestation and weighed 1965 grams. At birth, the obstetrician suspected
Downs syndrome (eg, trisomy-2l). A comprehensive history of the mother's preg-nancy and the
birth, as well as a comprehensive examination of the neonate, were documented. Presence of characteristics
associated with the chromosomal anomaly (eg, flaccid muscle tones), limbs comparatively short
for gestational age and as compared to trunk size, relatively flat nose bridge, were noted. Based on the
low birth weight and these suspicions, and despite the lack of noticeable physical distress (Apgar scores
were 4, 7 and 9 at 1, 5 and 10 minutes, respectively), the neonate was taken to the NICU for monitoring
and tests to examine the heart due to the prevalence of cardiac anomalies common to the syndrome.
Medical decision making was documented as moderate. The obstetrician performed an ultrasound,
which revealed a minor atrial septal defect, ostium secundum type. This finding did not necessitate immediate
surgery to correct the defect. A genetic test confirmed the diagnosis of nonmosiac trisomy- 21.
The infant was transferred from NI CU on day 2 to regular neonatal care where an expanded problem
focused interval history and expanded problem focused exam were performed with medical decision
making of moderate complexity. On day 3, a problem focused interval history and problem focused examination
we re performed with low complexity medical decision making. On day 4, the neonate was
discharged to home after the obstetrician spent 45 minutes with the parents giving instructions on how to
deal with the child's ongoing developmental issues and care. During the baby's hospital stay, the parents
also met with the hospital's genetic counselor who provided family support contact information.
The obstetrician scheduled a 15 minute weekly appointment for the next six weeks to monitor the infant's
progress. Code the obstetrician's services and the diagnoses for the neonate.
Answer:
Day 1 Day 2 Day 3 Day 4
99222, 76604-26 99232 99231 99239
764.07 765.28
745.5, 758.0
My question is that why I cannot code 99477 on the day 1 instead of 99222 ?
Downs syndrome (eg, trisomy-2l). A comprehensive history of the mother's preg-nancy and the
birth, as well as a comprehensive examination of the neonate, were documented. Presence of characteristics
associated with the chromosomal anomaly (eg, flaccid muscle tones), limbs comparatively short
for gestational age and as compared to trunk size, relatively flat nose bridge, were noted. Based on the
low birth weight and these suspicions, and despite the lack of noticeable physical distress (Apgar scores
were 4, 7 and 9 at 1, 5 and 10 minutes, respectively), the neonate was taken to the NICU for monitoring
and tests to examine the heart due to the prevalence of cardiac anomalies common to the syndrome.
Medical decision making was documented as moderate. The obstetrician performed an ultrasound,
which revealed a minor atrial septal defect, ostium secundum type. This finding did not necessitate immediate
surgery to correct the defect. A genetic test confirmed the diagnosis of nonmosiac trisomy- 21.
The infant was transferred from NI CU on day 2 to regular neonatal care where an expanded problem
focused interval history and expanded problem focused exam were performed with medical decision
making of moderate complexity. On day 3, a problem focused interval history and problem focused examination
we re performed with low complexity medical decision making. On day 4, the neonate was
discharged to home after the obstetrician spent 45 minutes with the parents giving instructions on how to
deal with the child's ongoing developmental issues and care. During the baby's hospital stay, the parents
also met with the hospital's genetic counselor who provided family support contact information.
The obstetrician scheduled a 15 minute weekly appointment for the next six weeks to monitor the infant's
progress. Code the obstetrician's services and the diagnoses for the neonate.
Answer:
Day 1 Day 2 Day 3 Day 4
99222, 76604-26 99232 99231 99239
764.07 765.28
745.5, 758.0
My question is that why I cannot code 99477 on the day 1 instead of 99222 ?