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Peds and neonatologist hospital rounds

  1. #1
    Location
    Greeley, Colorado
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    2,045
    Question Peds and neonatologist hospital rounds
    Medical Coding Books
    Suddenly, our pediatric newborn visits are being denied because the same codes were already submitted by a neonatologist. Does anyone else have this problem? If so, what are you doing about it? Is it necessary for peds and neonatology to both be following a premie/ill newborn?
    Lisa Bledsoe, CPC, CPMA

  2. #2
    Location
    Greeley, Colorado
    Posts
    2,045
    Question
    Anyone have any thoughts or experience with this?
    Lisa Bledsoe, CPC, CPMA

  3. #3
    Wink
    We had the same problem with our doctors and the neonatologist also billing on the same day. Here are a few things to consider:

    First, why are there 2 doctors following the patient?

    If the baby is indeed critical then at some point in time the neonatologist was contacted for care. Was the care turned over to the neonatologist or should it have been a consultation?

    Has the newborn stabilized enough that the care was or should be turned back to the pediatrician?

    Is this a result of the newborn being transferred from one facility to another? If this is the case then our pediatricians bill critical care time(99291-99292) and any procedures they perform to stabilize the newborn prior to transfer. Then the receiving hospital (neonatologist) bills the global critical care code (99468).

    For our physicians, they do not check on the baby until the neonatologist turns the care back over to them. Sometimes this happens within a day or two of discharge.

    It may be a misunderstanding between the 2 doctors as to who should be following the newborn, and this may need to be worked out between them.

    You could also try appealing insurance, stating they are 2 different tax identification numbers if that is the case. If both doctors are under the same tax identification number then only one should be billing.

  4. #4
    Location
    Greeley, Colorado
    Posts
    2,045
    Thumbs up
    Quote Originally Posted by wendym View Post
    We had the same problem with our doctors and the neonatologist also billing on the same day. Here are a few things to consider:

    First, why are there 2 doctors following the patient?

    If the baby is indeed critical then at some point in time the neonatologist was contacted for care. Was the care turned over to the neonatologist or should it have been a consultation?

    Has the newborn stabilized enough that the care was or should be turned back to the pediatrician?

    Is this a result of the newborn being transferred from one facility to another? If this is the case then our pediatricians bill critical care time(99291-99292) and any procedures they perform to stabilize the newborn prior to transfer. Then the receiving hospital (neonatologist) bills the global critical care code (99468).

    For our physicians, they do not check on the baby until the neonatologist turns the care back over to them. Sometimes this happens within a day or two of discharge.

    It may be a misunderstanding between the 2 doctors as to who should be following the newborn, and this may need to be worked out between them.

    You could also try appealing insurance, stating they are 2 different tax identification numbers if that is the case. If both doctors are under the same tax identification number then only one should be billing.

    Thank you for your reply Wendy. In 2 cases, the neonatal CNP was in attendance of delivery but the progress notes and hospital dictation do not state who is to be following the newborn. In both of these cases the only physician who followed the patient was our pediatrician. We are going to appeal based on TIN, different specialty, and that our doctor truly managed the care (as supported by the notes).

    Your feedback was very much appreciated!!
    Lisa Bledsoe, CPC, CPMA

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