Its Not Standby Any More:
New Code for Delivery Attendance
Published on Thu Jan 01, 1998
Pediatricians who are requested to be at a delivery now have a code they can use for that service. As of January 1, 1998 you can use 99436 for attendance at delivery. Dont even think of using the code for standby services (CPT 99360 ) any more.
The descriptor for 99436 is: Attendance at delivery (when requested by the delivering physician) and initial stabilization of a newborn.
The AAP requested the code for attendance at delivery because the only one that existed before was simply not accurate. Standby services indicates that the pediatrician isnt doing anything, the AAPs Office of Physician Payment Systems tells us. But they are doing something, and they need a code for it.
What the physicians are doing is initial stabilization. Any doctor will be able to use the code -- pediatricians, neonatologists, obstetricians, family physicians -- no code is doctor-specific, only procedure-specific. But it may be a relief to pediatricians to be able to code for what they are doing. For years pediatricians have been going to deliveries and havent been able to record, document and get reimbursed for what they are doing, the AAP notes.
While the new code is good news for pediatricians, will it really mean that health plans will start reimbursing them for attending normal deliveries? Possibly, because the very word standby is not in the descriptor. The term standby in the old description is the one word that lead managed care organizations to believe that pediatricians werent doing any work while attending the delivery. They were just standing by, notes Charles Vanchiere, MD, FAAP, CEO of an eight-physician group practice in Lake Charles, LA. But its ultimately a payor issue, admits Vanchiere, who also chairs the AAPs RBRVS Project Advisory Committee.
We have to use the new code and hope the payors reimburse for it, says Steven E. Krug, MD, FAAP, specialty advisor for pediatrics to the AMA RUC and a member of the AAPs RBRVS Project Advisory Committee. But the presence of a code does not assure reimbursement, adds Krug, who is associate professor of pediatrics at Northwestern and head of pediatric emergency at Childrens Memorial Hospital, both in Chicago. He notes that the pediatrician does do a considerable amount of work when he or she is summoned to a normal birth. And he adds that all of this work must be documented and should be reimbursed. Pre-service work includes showing up, reviewing the maternal records, talking briefly with the family, scrubbing, and preparing the warmer and resuscitation equipment, he explains. Delivery includes a brief assessment of the infant, one- and five-minute Apgar scores, and standard healthy newborn resuscitation, such as drying, stimulating, and suctioning.
About 20 percent of deliveries are [...]
