Ob-Gyn Coding Alert

Question: When is the ob/gyn that delivers the newborn entitled to bill for newborn care? Is the obstetrician entitled to reimbursement for performing an initial check of the child? If so, what codes should be used?

Adelia Cooley
Billing, Education, Audit Manager
Oakwood Ambulatory Administration
Dearborn, MI

Answer: The code for normal newborn care is 99431 (history and examination of a normal newborn infant, initiation of diagnostic and treatment programs and preparation of hospital records). This code is designed for use only once per child. As a result, even if an obstetrician performs the initial check of the infant, but a pediatrician sees the infant later or the next day, the pediatrician gets to use 99431. An obstetrician can only use this code if no pediatrician sees the child. An alternative for most obs is to bill newborn care as a consultation. If this is done, remember that the pediatrician must enter a consultation request in the patients chart and the ob must adequately document the care.

Another possibility that could occur is when a child is born in need of resuscitation, and no other qualified physician is present. If the ob performs resuscitative care, then his or her time can be coded using 99440. This should not conflict with the pediatrician when he arrives later and uses the 99431.