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Pediatric Coding Alert

Let Non-Critical Infant's Daily Condition Drive Inpatient E/Ms

Published on Wed Feb 16, 2005

Abnormal findings trigger shift from newborn to hospital care codes

Knowing when and how to transition from normal neonate care services to inpatient codes - and sometimes back again - can end your ill-infant coding dilemmas.

Sick Infant Requires Hospital Care Codes

When a normal newborn becomes sick but not critically ill, you should use the hospital care codes. "Code as you normally would for treating an ill hospital inpatient," says Richard Tuck, MD, FAAP, a member of the American Academy of Pediatrics (AAP) national committee on coding and nomenclature (COCN).

Method: When the infant is sick after birth, Tuck says, you should code based on these guidelines:
 
  • sick but not critically ill on the initial hospital day - use initial hospital care codes 99221 -99223 (Initial hospital care, per day, for the evaluation and management of a patient ...)

     
  • for each day the newborn continues to be sick - report subsequent hospital care codes 99231-99233 (Subsequent hospital care, per day, for the evaluation and management of a patient ...).

    For any days that the neonate is normal, you should assign a standard newborn care code (99431-99433).

    "Thus, you may move back and forth between newborn care and hospital care codes depending on whether the child has a significant problem that no longer qualifies as a 'normal newborn,' " Tuck says. You may think of this movement as the "coding continuum of care."
    How the sliding scale works:

    Normal newborn        sick newborn         critically ill newborn
      99431-99433           99221-99233              99295-99296

    Note: When a non-critically ill newborn is less than 2,500 grams, you may use 99298-99299 for subsequent hospital care.

    6 Findings Move Newborn Out of Normal Range

    Perhaps the trickiest part of coding newborn care services, however, is knowing when a non-critical newborn is sick. Knowing the criteria for a normal newborn can prove difficult, says Kathy Kalbfleisch, CPC, physician billing coding auditor at McLaren Regional Medical Center in Flint, Mich.

    You can differentiate between a normal and abnormal newborn by knowing how to define a normal infant and a sick neonate.

    Definition 1: A normal newborn is one who transitions from birth in a normal fashion and subsequently:

  • displays normal vital signs including normal color, respiration and cardiovascular status

     
  • begins and continues to feed, stool and urinate as expected

     
  • has no significant abnormalities on examination.

     
    Definition 2: In contrast, an abnormal newborn may exhibit the following condition(s):
     
  • abnormal vital signs, such as tachypnea, hypothermia, fever, tachycardia

     
  • abnormal metabolic findings, such as low glucose or calcium

     
  • anemia or polycythemia

  • signs of possible bacterial infection

     
  • jaundice requiring treatment.

    Hint:     To more readily identify the sick but not critically ill newborn, look for the following six findings, says Richard A. Molteni, MD, FAAP, a neonatologist and medical director at Children's Hospital and Regional Medical Center in Seattle:
     
  • hyperbilirubinemia requiring hospital therapy or additional close monitoring but not an exchange transfusion

     
  • a significant feeding problem that prolongs the patient's stay or requires gavage feedings but does not require the use of TPN

     
  • respiratory distress with tachypnea, retractions, grunting or flaring; including a need for supplemental oxygen, but does not require CPAP or mechanical
    ventilation

     
  • signs of potential infection, such as fever, hypothermia, leucocytosis or leukopenia without shock or the need for cardiovascular support

     
  • inability to maintain normal body temperature controlled with a warmer or isolette

     
  • hypoglycemia requiring IV glucose therapy only.

    Bottom line: "Any finding that prolongs an infant's stay or requires therapy probably warrants a sick code - meaning 99221-99233," Molteni says.

    Editor's note: Test your newborn-care coding skills in next month's Pediatric Coding Alert quiz.

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