Pediatric Coding Alert

Question: A pediatrician coded a newborn's hospital charges as an admit, two subsequent days and a discharge. The physician did not see the newborn on the discharge date and did the discharge paperwork the night before (the second subsequent day). Should I instead bill the second subsequent day as the discharge?


Wisconsin Subscriber

Answer: Yes. You should change the second subsequent day charge (such as 99433, Subsequent hospital care, for the evaluation and management of a normal newborn, per day) to your discharge day (99238-99239, Hospital discharge day management ...). You can only bill a discharge service when you have face-to-face contact on that day in the hospital.

Although the pediatrician does not see the patient on the final day, the physician is still responsible for his care. But this does not justify reporting services on that day. The chart must contain a face-to-face note on the day the service is billed.

The same rationale applies to a baby not seen by the physician on the date of birth. When a baby is born on day 1 and the pediatrician speaks with the nursery, gives orders, etc., but does not see the baby until day 2, you can't bill for day 1. You instead code for the initial face-to-face encounter (such as 99431, History and examination of the normal newborn infant, initiation of diagnostic and treatment programs and preparation of hospital records [this code should also be used for birthing room deliveries]) on the date the face-to-face occurs -- the baby's second hospital day.