Pediatric Coding Alert

In the March issue of Pediatric Coding Alert, Richard H. Tuck, MD, FAAP, an AAP coding trainer, answered some tricky questions about newborn coding. The questions were posed by a subscriber, who submitted three reimbursement dilemmas. The subscriber, Thomas J. Catalanotto, MD of Fairfield, OH, specializes in high-risk coverage for a neonatal intensive care unit. The answers led to some more questions from Patricia S. Wildman, RRA, clinical reimbursement auditor at Childrens Hospital in Boston, and explanations from Tuck, who practices in Zanesville, OH. Tuck would not change his recommendations for the first and third scenarios. For the second scenario, his recommendation holds, although there isas often happens in codingan alternate solution.

Scenario One

This involved attendance at a delivery in which there was thick particulate meconium. The infant was intubated two times and meconium was suctioned. Subsequently the infant was fine, and after one hour in the special care nursery for observation, went to the mother. Catalanotto coded this is 99436 for attendance at delivery and stabilization of the newborn, CPT 31520 for laryngoscopy/intubation and suctioning; and 99431 for care of the normal newborn.

Tuck commented that 99436 and 99431 are used properly. However, he suggested using 31500 (intubation, endotracheal, emergency procedure) instead of 31520 (laryngoscopy direct, with or without tracheoscopy; diagnostic, newborn). Since the pediatrician was intubating, not doing a diagnostic procedure, 31500 is more appropriate. 31520 is more for pediatric ENTs, says Tuck.

Wildman would prefer a newborn-specific code (99431normal newborn) in this case. 99436 includes initial stabilization of the newborn, she explains. Since this baby required no oxygen nor IV fluids and was returned to his mom within one hour, it appears this code covers all that was done. I would stay away from the 31500 code category since there are particular codes (99440 and newborn intensive care codes) that include intubation. These comes seem to be more specific for newborns.

Here is Tucks response to Wildmans comments:

I do agree that 99436 includes initial stabilization of the newborn, including resuscitation. It does not, however, include procedures. In this scenario, the infant was intubated with suctioning of meconium. 99440 (newborn resuscitation) does not include intubation, which is appropriately coded separately if done. The neonatal intensive care codes do not include 99440 (newborn resuscitation), but do include endotracheal intubation. This infant clearly does not warrant the use of these intensive care codes.

Scenario Two

This scenario involved attending the delivery of a 29-week premature infant. The baby required resuscitation at delivery, intubation and ventilation, IV fluids, plasmanate for stabilization of poor profusion, and an umbilical arterial line, prior to transfer to a Newborn Intensive Care Unit in Cincinnati. Catalanotto coded the case 99436 (attendance at delivery), 31520 (intubation), and 99291 (critical [...]