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Pediatric Admission Coding

  1. Default Pediatric Admission Coding
    Medical Coding Books
    I would appreciate input on the following pediatric coding scenario. If a baby is seen in the well baby nursery by a physician for a normal newborn admission, and is seen again later the same day for a problem that developed on the same day CPT allows billing for both admission codes using modifier 25 on the second code.

    If the newborn is admitted on Day 1 and a Normal Newborn admission code is billed and the baby becomes ill on Day 2, is it appropriate to bill a second admission code with the appropriate diagnosis on that day or should a subsequent hospital visit code be used.

    The same physician is rendering the service in both scenarios.

  2. #2
    I'm not to familiar with inpatient, but under the -Newborn Care Services- it states "When normal newborn services are provided by the same physican on the same date that the newborn later becomes ill and receives additional intensice or critical care services, report the appropriate E/M code with modifier 25 for these services in addition to the normal newborn code".

  3. Default
    I do not use the normal newborn codes once the newborn becomes ill, I use the 99221 - 99223 depending on the level on the initial date of service and the 99231 - 99233 for subsequent day. Of course if the you would use the subsequent codes if the newborn became ill on say second day of life.

    Hope this helps.

  4. #4
    Milwaukee WI
    Default Child requires NICU?
    Are you saying that the baby was so ill as to require intensive care in the NICU?

    If YES ... then I believe you can code the appropriate Pediatric / Neonatal initial critical care code. (BUT ... my NICU specialist is out on leave for the next several weeks, so I can't confirm with her.)

    Hope that answers your question.

    F Tessa Bartels, CPC, CEMC

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