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Newborn E/M questions

  1. #1
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    Daytona Beach, FL
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    Question Newborn E/M questions
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    I have a couple of questions my billing dept has due to insurance denials - if someone could help me that would be great. I'm pretty sure what the issue is, but I just would like to confirm as I'm not familiar with Newborn EM.

    #1 - I have a hospitalist who billed 99464 Attendance at delivery and also 99460 Intial Care - newborn. The insurance is denying the 99464 as included in the 99460. I don't see that it was billed with -25 modifier. Would this be the reason for denial and if so, which code would get the modifier?

    #2 - On another patient, the hospitalist billed 99462 subsequent normal newborn and then also billed 99468, Inital Neonatal critical care on the same dos. First they paid both charges, but now they are recouping the 99462 as incidental tp another procedure - would this also need the 25 modifier to pay - and again which code gets the modifier.

    Thanks all for the assistance!

    Jodi Dibble, CPC
    Last edited by jdibble; 06-15-2010 at 10:34 AM.

  2. Default Newborn E&M
    Answer for #1 - It may depend on the insurance company that you are dealing with, however it is the norm in our office for BOTH 99464 and 99460 to be paid to our neonatal hospitalists when billed for on the same DOS

  3. #3
    Location
    Daytona Beach, FL
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    Lclarke - Do you bill with a modifier or do you get paid without one?

    Thanks for you help.

    Jodi Dibble, CPC

  4. #4
    Location
    Daytona Beach, FL
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    Does anyone know if I need to add 25 modifier to one of the neonatal visits for both to pay and if so which visit?

    Thanks again!

    Jodi Dibble, CPC
    Jodi Dibble, CPC

  5. #5
    Default
    I had posted this question in a couple different areas of this forum and have yet to recieve a reply. Since you are familiar with newborn coding, would you know the answer to my question?

    I was wondering how to cpt code a newborn that is normal the first 2 days (99460 & 99462) and then on the 3rd day has tachypnea. Do we then code 99477 or 99480 or would it be 99221-99223?

    Thanks so much!

  6. #6
    Location
    Daytona Beach, FL
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    746
    Red face Trying to help....
    I actually am not familiar with newborn coding. I recently started coding for a group of Hospitalists and I am trying to correct errors that are being denied from the insurance - so I have been seeking answers to my question about why the Insurance is denying the code for the Attendance in the delivery room along with the initial newborn visit and an initial critical care visit billed with a subsequent normal visit - which seems on the same lines as your question.

    I have read through the CPT book and it is just not clear which codes to use. In your case, for the 99477 - it is not clear at all what they mean by Initial hospital care. The first sentence says the code "represents the initial day of inpatient care for the child who is not critically ill, but requires intensive observation". Depending on how you read this, it would seem that the key word is INITIAL DAY of inpatient care, which would imply that would be the first day the patient was in the hospital. Being the third day is the day the baby developed Tachypnea, I would say that would not be the correct code. I would possibly say then that the Subsequent code, 99478-99480 - depending on the childs weight - would be used. I can honestly say that based on the CPT book, you would not use the 99221-99223 series. It states to use these codes for the Initiation of inpatient care of the ill neonate NOT requiring intensive observation, etc and since this visit is not the Initiation of the care and the patient needs intensive care, these codes are not approptiate. The 99231-99233 series would also not be used as I'm sure the baby is not more than 5000 grams and also again requires intensive care.

    So, I think your correct choice would lie in the 99477-99480 series, but again, I would hesitate to use the Intial 99477 as I'm sure there was already an Initial visit on the date of birth. Unless someone can explain if the Intial is for the first day on the Intensive Care, regardless of the first day of hospital stay, I would use the subsequent codes.

    I don't know if this helps at all - and if anyone who does know about Newborn patient coding could answer your question and mine, I know we would both appreciate it greatly!

    Jodi Dibble, CPC
    Professional Coder
    Employed Physician Practice
    Newton Memorial Hospital
    Jodi Dibble, CPC

  7. #7
    Default
    Thanks for your research on my question Jodi!! I really appreciate you taking the time to help me figure this out.

  8. #8
    Location
    Daytona Beach, FL
    Posts
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    Default
    No problem! Keep us posted if you get any concrete answers to this - I would be very interested.
    Jodi Dibble, CPC

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