Pediatric Coding Alert

The problem of how to bill for your services when waiting for a laboring mother to deliver has not been entirely solved by 99436, the 1998 CPT code for attendance at delivery. Sometimes you may be waiting for quite a long time, but you cant use the standby code (99360), says Richard A. Molteni, MD, FAAP, who is on the CPT editorial panel. The answer lies with the obstetrician: you should only be called to attend high-risk deliveries or cesarean sections.

Standby cannot be used any longer for pediatrics, says Molteni, who is a member of the American Academy of Pediatrics RBRVS PAC and chair of the academys perinatal section. Only 99436 is applicable to pediatricians, he says. Standby has been reserved for the obstetrician.
99436 has actually taken the place of the old standby code for pediatricians attending at high-risk deliveries or C-sections, adds Molteni. We removed the words for the care of the newborn from the standby code, he notes.

The 1997 CPT defines CPT 99360 as physician standby service, requiring prolonged physician attendance, each 30 minutes (e.g., operative standby, standby for frozen section, for cesarean/high risk delivery for newborn care, for monitoring EEG). The current descriptor is the same, with the exception that the words for newborn care have been removed.

Molteni says that 99436 is only for high-risk deliveries and c-sections. This is implicit in the descriptor: Attendance at delivery (when requested by delivering physician) and initial stabilization of newborn. The phrase when requested by delivering physician is there to assure payers that hospitals with in-house staff who support these positions by having them go to all deliveries do not need to be paid for going when theyre not asked to, says Molteni, who is also the vice president and medical director of Childrens Hospital and Regional Medical Center in Seattle, WA.
99436 includes all routine care and observation of the newborn up to resuscitation. If positive pressure ventilation or chest compressions are required, the code is 99440 (neonatal resuscitation) instead of 99436. Blow-by oxygen is included in 99436.

But what code should pediatricians use when they are asked to be at a delivery that is not high-risk? We should not be asked to attend low-risk or no-risk deliveries, says Molteni. If we do that for the hospitals or obstetricians legal concerns, they should pay us if insurance will not.

Tip: Pediatric offices should work with local obs to be sure that when they are called to stand by for delivery, the ob indicates his request in the patients chart, and why it was made.