Pediatric Coding Alert

Question: How should we bill if our pediatrician examines a newborn (premature) in the hospital and then transports the baby? We are concerned about using the once-daily 99295, leaving the receiving neonatologist with no way to bill.

New Jersey Subscriber

Answer: The answer to your question depends on when the baby is born. In some cases, your pediatrician can bill 99295 (Initial neonatal intensive care, per day, for the evaluation and management of a critically ill neonate or infant), and so can the receiving neonatologist. For example, if a baby is born at 11:00 p.m., your pediatrician can bill 99295, and so can the receiving neonatologist because it will be the next day by the time the transfer is complete. If the baby is born at 10:00 a.m. and will be at the receiving hospital by 3:00 p.m., however, only one provider can bill 99295. Because the receiving neonatologist will be providing this care, allow him or her to bill 99295.

Even if your pediatrician does not bill 99295 due to timing, you should bill all other services provided. For example, if the baby requires resuscitation, bill 99440 (Newborn resuscitation: provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output). If the pediatrician is summoned to the delivery room to attend the birth, bill 99436 (Attendance at delivery [when requested by delivering physician] and initial stabilization of newborn). According to CPT, however, do not bill 99440 and 99436 together. Either one of these codes can be reported in addition to 99295. If not reporting 99295, you should use a hospital admission code instead (9922x). You can bill 9922x, and the receiving neonatologist can bill 99295 on the same day as long as the neonatologist is in a different group. If both have the same provider number, one cannot bill 9922x and the other 99295 on the same day.