Pediatric Coding Alert

Question: What is the correct way to bill for newborn care in the hospital to ensure the highest compensation? Do you recommend billing 99431 with all dates of service or breaking down charging to each day with a different code?

Ohio Subscriber

Answer: When seeing and treating newborns in the hospital, you should not group all services together using 99431 (history and examination of the normal newborn infant, initiation of diagnostic and treatment programs and preparation of hospital records [this code should also be used for birthing room deliveries]). The best way to bill for newborn care is as follows: If the baby is a normal newborn without complications, then the provider would use 99431 for the initial visit. If the child remains in the hospital for a day or two, then for any subsequent visits for normal care the code would be 99433 (subsequent hospital care, for the evaluation and management of a normal newborn, per day). A regular discharge code should be used for the day of discharge: 99238 (hospital discharge day management; 30 minutes or less) or 99239 (hospital discharge day management; more than 30 minutes).

If the initial care is on a normal newborn and the child will be going home the same day, then 99435 (history and examination of the normal newborn infant, including the preparation of medical records [this code should only be used for newborns assessed and discharged from the hospital or birthing room on the same date]) should be used as the initial assessment. Even if the child is born on one day and is seen the next day for only the physician visit, 99435 should be used. If the child has any type of complications and is not considered a normal newborn, then use the regular hospital admitting and visit codes or if appropriate, neonatal intensive care (99295-99298) or critical care codes (99291-99292).