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Thread: Newborn Diagnosis greater than 28 days old

  1. #1

    Default Newborn Diagnosis greater than 28 days old

    AAPC: Back to School
    My Neonate specialist's are using newborn diagnosis for babies greater than 28 days. In NY, GHI and HIP are denying the claims for "Diagnosis inconsistency with age". According to a resource one of my Doctors found it states "that if the baby acquired the condition during the first 28 days of life they should be able to use the newborn dx code after 28 days of life".
    Is this so, and if it is, how do we appeal to the insurance carriers? I cant find any guidelines on Medicare's webpage.....

  2. #2


    Never heard of this. Can he show you his source.

    The DX is assigned based on the age of the patient at the time of the encounter. Some providers feel once they have assigned a DX that it should never change.

    Maybe he is concerned changing the DX will lead to denials. Explain that it is just the opposite. That he will get "age" denials on his services if coding a newborn DX on a 45 day old infant

  3. #3


    Please refer to ICD-10 guidelines for chapter 16, at the beginning of the book.

    Chapter 16 Codes after the Perinatal Period rule number four.

    Clearly states:
    Should a condition originate in the perinatal period, and continue throughout the life of the patient, the perinatal code should continue to be used regardless of the patient’s age.

    I would send the claim to the insurance carrier with a copy of the ICD-10 guidelines, highlighting rule number four.
    Since this is a new rule allowing “P” codes to be used out of the 28 day rule.

    Make sure there is no comparable diagnosis code, for the same condition if the patient is older than 28 days.
    Also the provider’s documentation must support the newborn code.

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