Pediatric Coding Alert

Question: A newborn has been in the hospital for two weeks and our pediatricians have been rounding on him every day. Do I bill for the initial visit and then subsequent visits every day after?

Delaware Subscriber

Answer: Yes, if the patient's status warrants those codes. Newborn inpatients typically fall into one of four categories: Well care (99460, 99462), stable sick (99231-99233), intensive care sick (99477-99480), and critical care sick (99468-99469). You should review the documentation from the physicians' hospital visits or ask the pediatricians what kind of care this baby needed that required him to be in the hospital for over two weeks. It can be very complicated, because the condition of the baby can change over the course of his stay, so you may have to mix and match the appropriate code sets to accurately reflect the care given.

So, assuming the baby had a medical reason to be in the hospital for over two weeks, you will bill a daily visit. However, if the baby is only there because the mother is ill, then most likely the insurance company will not pay for those daily visits after a certain period of time (usually three to four days for a healthy infant).