Pediatric Coding Alert

Scenario 1: You perform a history and examination of a normal newborn in a birthing room on day 1. On day 2, the newborn shows emerging signs of jaundice that require treatment. You perform and document an expanded problem- focused interval history, an expanded problem-focused examination and moderate-complexity medical decision-making. For days 1 and 2, you should report, respectively:

a. 99232, 99431

b. 99431, 99232

c. CPT 99222 , 99232

d. 99431, 99433

Answer 1: b. You should report normal newborn care for day 1 with 99431 (History and examination 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]).

When the infant becomes ill requiring treatment on day 2, code the subsequent hospital care described as 99232 (Subsequent hospital care, per day, for the evaluation and management of a patient ...).

Scenario 2: On day 1, you find that an otherwise normal newborn has transient respiratory distress that requires you to perform a comprehensive history, a comprehensive examination and moderate-complexity medical decision-making. On day 2, the infant has clinical improvement in respiratory symptoms and is observed closely with more frequent vital signs. On day 3, the infant shows normal vital signs but remains in the hospital due to the mother's recovery from a cesarean section. You should code each day's E/M as:

a. 99431, 99433, 99433

b. 99222, 99232, 99232

c. 99222, 99231, no service

d. 99222, 99231, 99433

Answer 2: d. When the infant is ill on day 1, you should report the appropriate initial hospital care code: 99222 (Initial hospital care, per day, for the evaluation and management of a patient ...). Also use a hospital care code (99231, Subsequent hospital care, per day, for the evaluation and management of a patient ...) on day 2, when the newborn requires additional close monitoring.
 
Because you find the newborn is normal on day 3, use subsequent normal newborn care code 99433 (Subsequent hospital care, for the evaluation and management of a normal newborn, per day).

Scenarios provided and/or reviewed by Richard A. Molteni, MD, FAAP, a neonatologist and medical director at Children's Hospital and Regional Medical Center in Seattle; and  Richard Tuck, MD, FAAP, a member of the American Academy of Pediatrics national committee on coding and nomenclature.