Pediatric Coding Alert

Question: My pediatrician was the primary care provider for a baby who was born to a mother who was addicted to drugs. The mother was on methadone, and as a result the baby had to stay in the hospital for five weeks on a withdrawal program. How should we bill for the 42-day daily inpatient check my doctor performed?

South Carolina Subscriber

Answer: You should bill each day's care using two sets of codes: one for the newborn care (through the 28th day) and one for the infant care (from the 29th day through the 41st day).

On day 1, if the newborn required intensive observation and frequent interventions, you would use 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).

Then, for days 2 though 28, you would choose a code based on the newborn's daily weight. You will probably begin by using 99479 (Subsequent intensive care, per day, for the evaluation and management of the recovering low birth weight infant (present body weightof 1500-2500 grams)) and eventually move to 99480 (... (present body weight of 2501-5000 grams)) depending on the body weight your provider documents in each daily note.

For days 29 through 41, you'll assign the appropriate level of subsequent hospital care with 99231-99233 (Subsequent hospital care, per day, for the evaluation and management of a patient ...). You would then go ahead and report the discharge with 99238 (Hospital discharge day management; 30 minutes or less) or 99239 (... more than 30 minutes).

However, all of the coding is dependent on how ill the neonate/baby is at birth and during the following days. If the infant is not critical, then 99477 would be correct for the initial day. But if the baby is basically just being watched for withdrawal, and your pediatrician conducts no further testing, then depending on your provider's documentation, the subsequent hospital care codes (99231-99233) may be appropriate if the documentation is not there to support the 99479 codes.

Whichever way you code the encounter, however, you'll use a diagnosis code of P96.1 (Neonatal withdrawal symptoms from maternal use of drugs of addiction) to accompany the evaluation and management (E/M) services.