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Normal newboorn becomes ill same day...

  1. #1
    Location
    Greeley, Colorado
    Posts
    2,045
    Question Normal newboorn becomes ill same day...
    Medical Coding Books
    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

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default Didn't we have this question already?
    Lisa,
    I'm having deja vu or this question was previously asked ...

    Anyway. If the child was not critically ill then I'm not sure you can capture anything.

    Read the guidelines under "Initial and Continuing Intensive Care Services" (CPT 2009 professional edition, pg 35). They read IN PART: For the subsequent care of the sick neonate less than 28 days of age but more than 5000 grams who does not require intensive or critical care services, use codes 99231-99233.

    But I really don't know if you can use the subvisit codes on the same day as you use 99460.

    Even if the child was under 5000 grams you still wouldn't want to use the 99477 code because that would be what the neonatologist in the NICU uses. And it can only be used one time.

    Let us know how you decide to proceed and the results.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Location
    Greeley, Colorado
    Posts
    2,045
    Wink Yes - repeat question
    Hi Tessa - I had posted it onto another thread and didn't see a response, so I re-posted to it's own thread. I'm thinking about doing a subsequent visit with mod -25 since it is a different problem (the baby had no symptomology at the time of delivery/admission). Thoughts?
    Lisa Bledsoe, CPC, CPMA

  4. #4
    Location
    Milwaukee WI
    Posts
    4,466
    Default It's worth a try
    I'd say it's worth a try to bill the subvisit with -25 mod. Clearly the additional visit was medically necessary.

    If you get a denial, appeal with progress notes.

    Good luck!

    F Tessa Bartels, CPC, CEMC

  5. #5
    Location
    Greeley, Colorado
    Posts
    2,045
    Wink
    Thanks Tessa, as always, for your input/expertise.
    Have a super day!
    Lisa
    Lisa Bledsoe, CPC, CPMA

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