Pediatric Coding Alert

Are you receiving one-third less for 99460- 99465? Here's what to do. You know insurers aren't Flash Gordons when it comes to implementing coding changes but recent cuts on the normal newborn hospital care CPT 2009 codes take the cake. "Monitor your statements to make sure you're getting paid appropriately for 99460-99465," says Richard Tuck, MD, FAAP, pediatrician at PrimeCare of Southeastern Ohio in Zanesville. "We found that our Medicaid was paying us significantly less (about one-third less) for the new codes than the old codes (99431-99440)." Why: Medicaid has since corrected the administrative error that resulted from not realizing that the 99431-99440 to 99460-99465 code revisions involved no descriptor change, but were a direct crosswalk. When the administrator inputted the codes, she applied a standard new code deduction. Because the code changes reflected only renumbering to make room for more codes as needed, the fee change does not apply. [...]