Pediatric Coding Alert

Keep track of when the admission actually takes place.

You may never collect the $121 allotted for 99463 unless you’re vigilant about keeping an eye on the calendar.

Background: The descriptor for code 99463 specifically states, “Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant admitted and discharged on the same date.” But many pediatric practices are curious about what happens if the baby’s stay spans multiple dates. Check out our examples, along with an alternative coding option for non-same-day admits and discharges.

Use 99463 When Admission, Discharge Dates Match

Most payers take a literal approach to interpreting the same-day admit and discharge code, and adopting this strategy can help you prevent a stack of denials. You should avoid reporting 99463 when you have separate calendar dates for your services, as follows:

• One date for the initial face-to-face visit and hospital admission
• One date for the history and physical (H&P) and discharge.

Instead, you should focus on 99463 when you perform both services on the same day.

Example: A mother delivers her son vaginally at the hospital after an uncomplicated pregnancy. The pediatrician presents to the hospital in the evening of the same date and completes both the admission and discharge examination and the hospital paperwork for the patient, who is then sent home. He schedules a follow-up appointment for the baby in the office later that week.

Advice: You can report 99463 because both the admission and discharge occurred on the same date of service.

Caveat: Some payers will allow you to consider the “admission” date as the date the pediatrician actually sees the baby for the first time and processes the admission paperwork. In these cases and if your insurer allows it, you can bill 99463 in this scenario.

Example: A pediatrician finishes rounds at 8 p.m. and a newborn is born at 9 p.m. When the pediatrician first sees the patient on rounds the next day, the newborn is almost 12 hours old. The pediatrician performs the normal newborn assessment and admission paperwork, during which the mom requests to go home the same day. The pediatrician says she can go home later that evening provided the baby continues to have wet diapers, have stools, and is nursing or bottle feeding. The physician then writes orders for the infant’s discharge and also writes the discharge note. In this case, report 99463 to represent the same-day admission and discharge.

Split Coding for Split Days

If your pediatrician sees the patient on the date of birth and admits her, then returns a day or two later to process the discharge, you’ll report the individual normal newborn care (99460, Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant) and discharge (99238, Hospital discharge day management; 30 minutes or less ...; or 99239, ... more than 30 minutes) codes.

Example: The pediatrician sees a two-hour old baby on Wednesday afternoon. He performs a full assessment and completes the admission paperwork. He returns to the hospital at 8 p.m. on Thursday, examines the child, confirms that she is breastfeeding successfully and voiding after each feeding, and discharges the child. In this case you’ll report 99460 on Wednesday and 99238 on Thursday.

Payment stats: You’ll collect approximately $53* less for using the combination code (99463), rather than reporting the individual admission (99460) and discharge (99238) codes. Code 99463 has increased reimbursement ($121) compared to 99460 ($100) to represent the included discharge. Because the discharge is somewhat combined with the assessment work, 99463 pays less than reporting the individual codes together, which combined pay approximately $174. *Figures are based on the 2015 Medicare Physician Fee Schedule that pediatricians can use to gauge private payers’ rates.