Pediatric Coding Alert

In the January 1998 issue of PCA we described the new attendance at delivery code -- 99436 -- which allows you to code for when you are requested to attend a delivery and you provide initial stabilization of the newborn. While this new code does help solve the standby reimbursement problem, there are still questions about how to code for normal, subsequent and discharge newborn care.

Normal Care Codes:

The main code is 99431. The descriptor is: History and examination of the normal newborn infant, initiation of diagnostic and treatment programs and preparation of hospital records. Also, according to the CPT book, This code should also be used for birthing room deliveries. The attendance at delivery code (99436) can be used in addition to 99431.

For normal newborn rounds, you should use the code for subsequent hospital care (99433).

(Tip: If the baby is discharged from the hospital so soon that you only see the patient once, you should use 99435 for the history and examination. This code has a higher value, in recognition of the fact that you are assessing and discharging the baby at the same time.)

Subsequent Care Codes:

There may be a problem which requires more than 99431 or 99433. If the problem occurs on the first day, such as a birth trauma, you would use the code for initial hospital care (99222). This code requires three key components: a comprehensive history, a comprehensive examination, and medical decision-making of moderate complexity. Physicians typically spend 50 minutes at the bedside and on the patients hospital floor or unit, according to the CPT book.

What if the problem develops on the second day, such as jaundice? You should have used 99431 for the initial exam. But instead of using 99433 for subsequent hospital care, you should use CPT 99232 , says Richard H. Tuck, MD, FAAP, a founding member of the AMAs RBRVS RUC. If the illness develops on the first day, you should use 99222 or, more likely, 99223, says Tuck, who practices in Zainesville, OH. If it develops on the second day, go back to the subsequent hospital care codes.

You would use 99232 for a problem that develops on the second day a newborn is in the hospital; 99231 by definition is for a patient who is improving or stable. 99231 is for subsequent hospital care involving at least two of the following: a problem-focused interval history, a problem-focused examination, and medical decision making that is straightforward or of low complexity. Usually, the patient is stable, recovering, or improving, the CPT book states. Physicians typically spend 15 minutes at the bedside and on the patients hospital floor or unit. 99232 is for subsequent hospital care involving at least two of the following: an expanded problem-focused interval history, an expanded problem-focused examination, and medical decision making of moderate complexity. Usually, the patient is responding inadequately to therapy or has developed a minor complication, the CPT book states. Physicians typically spend 25 minutes at the bedside and on the patients hospital floor or unit. You might also have to use 99233 if the patient is unstable or has developed a significant complication. 99233 requires at least two of the following: a detailed interval history, a detailed examination, and medical decision making of high complexity.

Occasionally a problem arises which resolves on its own, such as transient tachypnea, adds Tuck. If the problem rectifies within a few hours, it would then be a normal newborn and you would use 99433 for subsequent care, or 99431 for initial care, he says.

(Tip: If this problem requires the pediatricians attendance at the bedside for more than 30 minutes, then you can use 99356 and 99357, for prolonged services in the hospital.)

Discharge Codes:

The main codes at discharge are 99238 (30 minutes or less) and 99239 (more than 30 minutes). However, as stated earlier, if you are seeing a newborn for the first and only time because the baby is being discharged on the same day as he was admitted, you would use 99435, since you are assessing and discharging the baby at the same time.

(Tip: Finally, Tuck has a tip for pediatricians who may have trouble getting reimbursed for the new attendance at delivery code. The obstetrician can consult the pediatrician at the time of delivery, says Tuck. Bill the consult codes on the baby, and put a copy of your notes in the mothers chart.)