Pediatric Coding Alert

Question: An ob-gyn called our pediatrician into the delivery room for a consult, and the pediatrician had to resuscitate the newborn. How do you suggest coding this? Should we use the consult codes (99251-99255) with modifier 25 appended along with 99465, or should we use the attendance-at-delivery code 99464 with 99465?

Answer: Insurers will not typically reimburse both 99464 (Attendance at delivery [when requested by the delivering physician or other qualified health care professional] and initial stabilization of newborn) and 99465 (Delivery/birthing room resuscitation, provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output) during the same session. 

CPT® specifically states, “Do not report 99464 in conjunction with 99465.” Therefore, you should always bill 99465 when you perform both delivery-room attendance and resuscitation. The work of attending a delivery is included in the relative value of 99465, which has a significantly higher payment than 99464.

In this case, if the pediatrician used resuscitation (bag and mask positive-pressure ventilation) you should report 99465. If the “consultation” you refer to was simply a request to attend the delivery, the pediatrician should not report any E/M services. If the physician performed only initial stabilization without resuscitation, you should report 99464 instead of 99465.