ED Coding and Reimbursement Alert

Question: If a baby is born in the emergency department, and the ED physician examines the baby or has to perform a procedure on the baby, how should I bill these services? Are they included under the mother's evaluation, or are the mother and baby two separate patients?

Oregon Subscriber Answer: In this scenario, you should approach the mother and baby as two separate patients. You may consider reporting code 99431 (History and exam of the normal newborn infant, initiation of diagnostic and treatment programs and preparation of hospital records. [this code should also be used for birthing room deliveries]) for deliveries that take place in the ED.
 
However, you should also keep in mind that 99431 requires evaluation of more than three Apgar criteria and a quick examination while rushing up to labor and delivery. Apgars are tests that physicians perform immediately after delivery to assess fetal well-being. They involve a very detailed assessment of color, tone, and respiratory effort, among other criteria.

Contained within the code definition is the requirement for initiation of diagnostic and treatment programs and preparation of hospital records. Any procedures performed on the infant are generally reimbursable separately from the delivery.