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When to bill 99461

  1. Question When to bill 99461
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    Hello,
    Is the use of this code for newborns under 2 weeks old who are brought to the office setting before thier normally scheduled 2 week check up with thier pedicatrician?? I have to tell you I am a little confused by the definition of this code in the CPT coding book. Can the Pedicatrician use this code when seeing a new born under 14 days old at the office with a Hospital discharge or is this for when Mom gives birth at home or a birthing center and they bring the newborn into the office for a check up to make sure all is well??

    Any help would be appreicated!!!! Thanks, Jenn

  2. #2
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    Quote Originally Posted by jsrumples View Post
    Hello,
    Is the use of this code for newborns under 2 weeks old who are brought to the office setting before thier normally scheduled 2 week check up with thier pedicatrician?? I have to tell you I am a little confused by the definition of this code in the CPT coding book. Can the Pedicatrician use this code when seeing a new born under 14 days old at the office with a Hospital discharge or is this for when Mom gives birth at home or a birthing center and they bring the newborn into the office for a check up to make sure all is well??

    Any help would be appreicated!!!! Thanks, Jenn
    Jenn, 99461 is used for intial physician contact in places other than the hospital or birthing center. The AAP says that 99461 can be used for initial office contact following birth (as long as no provider from the practice has previously seen the baby in the hospital or birthing center) for circumstances like home or taxi cab birth, but cautions that payers don't like to see this code with POS 11.

    I think the AMA's place of service intention for 99461 is for out-of-the-ordinary delivery places like correctional facilities, homeless shelters, etc. where a physician might provide initial newborn care.

    Hope this helps.

  3. Default
    99461 Is the code we use for the initial exam on an infant who was born at home. It is the home birth version of 99460.

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