Pediatric Coding Alert

Question: I am having problems with the newborn code 99431 and the resuscitation code 99440 being bundled, and the 99431 being disallowed. I did use modifier -25. Can you help?

Anonymous Ohio Subscriber

Answer: If the infant recovers from respiratory or cardiac arrest and you go on to provide the normal newborn physical, it is correct to bill both codes: 99431 (history and examination of the normal newborn infant, initiation of diagnostic and treatment programs and preparation of hospital records) and 99440 (newborn resuscitation: provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output). The -25 modifier (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) should not be necessary, but you can attach it to the 99431 to ensure payment.

Sources for answers to Reader Questions and You Be the Coder: Thomas Kent, CMM, president, Kent Medical Management, Dunkirk, MD; Richard H. Tuck, MD, FAAP, practicing pediatrician, Zanesville, Ohio; AAP Winter Coding and Reimbursement Update January 2000.