Pediatric Coding Alert

Question: Our pediatrician was making rounds at the local hospital and transferred a newborn patient to the neonatal intensive care unit (NICU). Which code should I use to report this: 99460 or 99477?

Arizona Subscriber

Answer: The difference between coding 99460 (Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant) and 99477 (Initial hospital care, per day, for the evaluation and management of the neonate, 28 days of age or younger, who requires intensive observation, frequent interventions, and other intensive care services) depends on the level of care the newborn needs.

Coding 99460 implies a level of care that does not require tests, monitoring, or other kinds of interventions above and beyond those necessary for a “normal” child. When that level of care is necessary for a neonate, you would report 99477.

Since transfer to a NICU implies the child needs intensive care, 99477 would seem the more appropriate choice in this situation.