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Seeking input on unusual case (for us)

  1. #1
    Default Seeking input on unusual case (for us)
    Medical Coding Books
    One of our ortho surgeons was asked to consult on a new born with a fractured humeral shaft. This is related to/result of an urgent c-section (we saw the patient the day following birth)
    I am wondering what E/M service code I should look to. This particular insurance does not allow for consultation codes to be billed. I initially looked to the admission code 99221 or 99232 (since not much of a history since less tha n24 hours old and completely healthy) - but then it was suggested to use 99460 (Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant) - but after reading the lay description, I'm not convinced that is the best code.

    Any thoughts on this? Has anyone encountered this before?
    It is a very first for us.

  2. #2
    Lansing, Michigan
    Hi, Since your doc isn't doing the "normal newborn care" and there isn't enough HPI for the lowest level new inpatient visit, then you would go to the subsequent inpatient visit codes. (99231-99233)

    Also, since the baby doesn't have "a lot of history", the doc could have documented his floor/unit time... and coded from that.

    Hope this helps, and good luck!
    Amanda Gibson, CPC
    Coding Analyst
    Memorial Medical Associates

  3. #3
    Thank you for your input, Amanda. That is exactly what I was thinking too.
    Enjoy your week.

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