Pediatric Coding Alert

You can confidently use a new tool in your initial newborn coding regimen provided you grasp 99477's criteria.

To determine which newborn care qualifies for new-for-2008 code 99477, effective Jan. 1, follow these guidelines.

Get acquainted with a third tier coming to your newborn coding continuum Jan. 1. For initial hospital care of a newborn (less than 28 days old), you currently have only two coding options: either hospital admission (99221-CPT 99223 , Initial hospital care, per day, for the evaluation and management of a patient ...) or critical care (99295, Initial inpatient neonatal care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or less).

In 2008, you'll have a third option: 99477 (Initial hospital care, per day, for the evaluation and management of the neonate, 28 days of age or less, who requires intensive observation, frequent interventions, and other intensive care services). "This is meant as an in-between code for initial care of a really sick, noncritically ill infant," says Richard H. Tuck, MD, FAAP, a pediatrician at PrimeCare of Southeastern Ohio in Zanesville. "Code 99477 fills the gap between 99223 and 99295," he explains.

Action: Think of 99477 as another care level, not a replacement code. You will still use 99221-99223 for newborns in some instances, says Linda Walsh, Committee on Coding and Nomenclature manager and Division of Health Care Finance and Quality improvement director for the American Academy of Pediatrics in Elk Grove Village, Ill.

You'll use 99477 when a newborn requires intensive services, but not critical care services. CPT creates the new E/M admission day service for neonates (babies less than 28 postnatal days of age) "whose level of illness does not reach the CPT definition of critically ill (99295) but who require a level of observation and monitoring that exceeds that normally expected and utilized for the admission of a sick child less than 28 days of age," says Richard A. Molteni, MD, FAAP, an AMA CPT advisory committee member. Choose 99221-99223, 99477 or 99295 based on the level and intensity of the neonate's illness and the intensity of monitoring, not on the site of service.

Two items will help you pinpoint scenarios that qualify for 99477. Check the patient's:

1. monitoring level. The patient needs to be sick with a need for intensive monitoring and observation

2. care locale. The level of intensive monitoring and observation associated with 99477 "is commonly provided in a special care or intensive care environment," Molteni notes. But this is not a requirement of the code.

These are the cases that you currently report as level-three initial hospital care that require a higher intensity and complexity of care than 99223's value includes. "These newborns often have a need for oxygen, thermoregulation, continuous or frequent vital sign monitoring, parenteral therapy, and frequent assessments by the healthcare team under direct physician supervision," Walsh describes.

If a newborn does not meet the aforementioned criteria, you should report the admission with 99221-99223. For example, admission of a newborn with mild hyperbilirubinemia (774.6, Unspecified fetal and neonatal jaundice) or mild hypoglycemia (775.6, Neonatal hypoglycemia) would most likely fall under 99221-99223, rather than 99477, Walsh indicates.