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Thread: NB eval and discharge sick baby same day

  1. #1
    Join Date
    Apr 2007

    Default NB eval and discharge sick baby same day

    AAPC: Back to School
    If a baby is born normal and then gets bad, what code do you use to transport baby out? The baby was kept for the duration of the day on O2 and tried to wean but not able. Chest x-rays done and was decided to transfer baby out to a different hospital. Do you use the code 99463 or is there another code that is better for the pediatricians E/M code?

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default Read the CPT Guidelines

    Read the CPT Guidelines - 2009 CPT professional edition, page 32, bottom of right hand column. They read in part: When normal newborn services are provided by the same physician on the same date that the newborn later becomes ill and receives additional intensive or critical care service, report the appropriate E/M code with modifier 25 for these services in addition to the normal newborn code.

    And on page 33, right hand column we find: If inpatient critical care services are reported in the referring facility prior to transfer to the receviing hospital, use the critical care codes (99291, 99292).

    It's hard to tell from your note if the baby was critically ill. But I do think you are on the right track.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Join Date
    Apr 2007
    Greeley, Colorado

    Question similar question

    Normal newborn 99460 reported by Dr. B; later same day Dr. C (same practice) is called to evaluate patient because he is not feeding/latching and was born to a insulin dependent mom; What would I code for Dr. C with dx codes 779.3 and 775.0. I see nothing in the note to support critical care, just transfer to NICU.
    Lisa Bledsoe, CPC, CPMA

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