# E&M evaluation postmortem



## tkeeton7885 (Sep 10, 2008)

We had a newborn delivered in our hospital facility. The newborn lived approx 45 minutes and the pediatrician examined the child postmortem. What E&M code would be appropriate for this service? Thanks in advance!


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## Belinda Frisch (Sep 10, 2008)

*Post Mortem Examination*

In our facility, though I have not had to do this with a newborn, our policy is to bill a discharge (99238-99239) for postmortem examination and completion of the death certificate in line with CMS guidelines.

"Only the physician who personally performs the pronouncement of death shall bill for the face-to-face Hospital Discharge Day Management Service (CPT codes 99238 or 99239).

The date of the death pronouncement shall reflect the date of service on the calendar date it was performed even if the paperwork is delayed to a subsequent date."

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5794.pdf

If the infant was ever considered "admitted" this might be an option, or may point you in a general direction.


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## jamee (Sep 10, 2008)

*Newborn Infant*

In reading this question, I find there are alot of unanswered questions that would allow appropriate coding.

My first response is why is the pediatrician examining a child that was deceased.  So more informatio nis needed such as did the family request the examination. Did the pediatrician provide resuscotation and could this be critical care of a newborn?  Did the OB request the consult.  Was there no mortician available that could pronouce the death?

Without additional information I would code this as a Non-billable service.


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## Belinda Frisch (Sep 11, 2008)

I hate to disagree, but it seems to be that this person is unfamiliar with the concept of "pronouncement of death". You stated the exam was a post mortem exam, correct? That indicates to me that the child was deceased at the time the physician examined him/her. "Morticians" are those people that deal in the management of funerals and are not hospital employees. A post mortem examination confirms death and is the predecessor to the completion of a death certificate. In our hospital, it is done by a variety of physicians depending on service line and/or hour of the day. You cannot be called for "advice or opinion" (i.e. consult) on a patient that is already deceased.



jamee said:


> In reading this question, I find there are alot of unanswered questions that would allow appropriate coding.
> 
> My first response is why is the pediatrician examining a child that was deceased.  So more informatio nis needed such as did the family request the examination. Did the pediatrician provide resuscotation and could this be critical care of a newborn?  Did the OB request the consult.  Was there no mortician available that could pronouce the death?
> 
> Without additional information I would code this as a Non-billable service.


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