Pediatric Coding Alert

Question: If a baby is born on Sept. 6 and assessed and discharged on Sept. 7, should we bill 99435? Also, there is no relative value unit (RVU). What is the price range?

Minnesota Subscriber

Answer: Billing 99435 (history and examination of the normal newborn infant, including the preparation of medical records [this code should only be used for newborns assessed and discharged from the hospital or birthing room on the same date]) is correct for an assessment of a normal newborn if the pediatrician both sees the infant for the first time and does the initial assessment and discharge at the same time.

Normally, the price is more than the initial visit, but not twice the amount of the same visit. A consistent way to determine the correct charge is to use the RBRVS. The RVU for 99435 is 2.64. To arrive at a fee, multiply 2.64 by the Medicare conversion factor, which is $36. That gives you $95.04. Ideally, you want your fee schedule to be approximately 130 percent of Medicares, so for 99435, you should list $123.55 (or $124).

Note: For more on RBRVS, see story on page 83.