Pediatric Coding Alert

In the February issue of PCA, we discussed the use of 99432 (normal newborn care in other than hospital or birthing room setting). Some pediatric practices are using this code inappropriately. It pays better than CPT 99391 (the preventive care services code for children under one year), but we said in the story that 99432 is to be used when a pediatrician travels to a home or a birthing center to examine a newborn. However, there are circumstances under which the code is used for services provided in the pediatricians office, as well.

Code 99432 is the only code you can use when a baby was born in a home, then brought to your office for the first exam. This is a fairly frequent occurrence at Baylor Pediatric Center, a three-physician, one-nurse practitioner practice in Dallas, TX. Her pediatricians use 99432 when a mother delivers at home or at a birthing center, says Jennifer Bell, practice administrator, and brings the baby to the office within the first hours of life for the newborn exam. This is the only time Bell uses 99432 for an office visit. The pediatrician performs the same type of exam that would be performed in the hospital, says Bell. The pediatrician does not need to travel to the birthing center or home in order to use this code.

In fact, CPT states that 99432 is for normal newborn care in other than hospital or birthing room setting, including physical examination of baby and conference(s) with parent(s). It doesnt say that the pediatrician has to travel to the place where the baby was born.

This is the real purpose of 99432, says Kim Rockwell, ART, CCS, CCS-P, the coding auditor for Bells group. Codes 99431 and 99432 are complementary codes, she says. While 99431 is for normal newborn care in the hospitalthe description specifically refers to the preparation of hospital records99432 is for normal newborn care for babies born elsewhere, says Rockwell. If the baby is born at home and the parents bring it to the pediatricians office, 99432 is the best code to use, she says. The pediatrician doesnt have to go to the home to use that code.

However, Rockwell acknowledges that the fee difference between 99431 and 99432 (99432 reimburses higher) is probably due to the fact that there is a greater chance that the pediatrician would have to go to the baby. If the baby were born at home, its possible that the mom wouldnt want to go out right away, and the parents might request that the pediatrician come to them, she says.

The diagnosis code for the baby born at home would be V30.20. The fourth digit (2) indicates that the baby was born [...]