Pediatric Coding Alert

Question: A neonatologist was called into the delivery room for a consult and had to resuscitate the newborn. How should we code this? Should we use the consult codes (99251-99255) with modifier -25 and 99440, or should we use the attendance at delivery code 99436 with 99440?

Virginia Subscriber

Answer: First, CPT specifies that you cannot report both 99436 (Attendance at delivery [when requested by delivering physician] and initial stabilization of newborn) and 99440 (Newborn resuscitation: provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output). Keep in mind that 99440 has a significantly higher relative value than 99436. Therefore, you should always report 99440 when you have the choice of 99436 or 99440.

In the situation you describe, if resuscitation (bag and mask positive pressure ventilation) was required, you should report 99440. If the "consultation" is only for the purpose of attending the delivery, you would not report an E/M code. Instead, you would report either 99436 or 99440 (Positive pressure ventilation). The neonatologist in this instance cannot provide consultation services for a newborn until after the baby is born and resuscitated.

Answers to Test Yourself and the Reader Question were provided by Shirley Fullerton, CMBS, CPC, CPC-H, academic director for the Medical Association of Billers in Las Vegas and a coder for MedQuist, a national Internet coding and transcription company based in New Jersey; and Richard Tuck, MD, FAAP, practicing pediatrician with Primecare Pediatrics of Zanesville, Ohio.