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Normal newborn care and ill care on the same date

  1. #1
    Urbana, IL
    Question Normal newborn care and ill care on the same date
    Medical Coding Books
    Hey all, need some thoughts on NB care:

    I understand that we are able to bill both a code from series 99460-99463 and 99221-99233, respectively for initial date of service or subsequent date with the -25 modifier if the baby develops an illness later in the day following the normal NB care. However; if a patient is ill and seen for both normal care and ill care during the same rounding can we spilt bill both codes? It would appear that the RVU in the 99221-99233 series does not include the RVU of codes from series 99460-99463. I also checked the NCCI and see no bundling which leads me to think that the Physicians are able to report both codes to capture their work appropriately.

    Any thoughts or accredited information would be much appreciated. I have reviewed CPT Changes 2009, Ingenix Learning: Understanding E/M Coding 2009, CPT Principles 5th addition (of course with out the 2009 codes ), CPT Assistant March09 Volume 19, Issue 3, The Coding Institute, the AAP (limited access), and the AAFP (limited access).

    I think the next step is to query the AMA on it but thought I'd check with my fellow Coders at the AAPC first.
    Dawn Peterson
    Coding Consultant/Billing and Coding Instructor
    Illinois, USA

  2. #2
    Hi Dawn,
    I am also working on these codes and getting information together for my Peds providers who have questions. Are you saying that you'd use a 99460-99463 code on the same day as an admit code 99222 or 99223? I think that if the newborn is not a "normal newborn" and has some medical issue, the admit code is used in place of the 99460 code. Or, according to CPT, if they later become ill, the intensive care or critical care codes are used. They would have only one "initial" code per day.

    If they are ill, I don't see how you could break the care into the normal care and the ill care. There would just be one code for all the follow up care visits, whether it be 99231-99233 or intensive or critical care codes, or if they are better, then 99462 or a discharge.

    Any more information on this is appreciated! There are so many scenarios that could arise and now all these different codes for babies!
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    National Advisory Board Member 2018-2021, Region 6 Great Lakes
    Minneapolis AAPC Chapter, Education Officer 2018
    AHIMA ICD-10-CM/PCS Trainer
    AAPC National ICD-10 Trainer

  3. #3
    Urbana, IL
    Hi there,
    Thanks for your thoughts. If the newborn is normal on the initial visit then needs to be re-examined later in the same day I am following the CPT nomenclature that allows both the normal NB initial or subsequent care code on the same date and the problem codes, be it the 99221-99223 or appropriate critical care or intensive care codes for the re-examination. This is clearly explained in the CPT Assistant from March 09.

    I think that I am reading into this too much leading me to think that the codes have the possibility of being split for the same encounter. I'll share if I find concrete evidence nixing the idea or supporting it.
    Dawn Peterson
    Coding Consultant/Billing and Coding Instructor
    Illinois, USA

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