Pediatric Coding Alert

Question: If a baby is brought into the doctors office for an exam two or three days after birth, is it appropriate to use code 99432?

Florida Subscriber

Answer: No, in this case it is not appropriate to use code 99432 (normal newborn care in other than hospital or birthing room setting, including physical examination of baby and conference[s] with parent[s]) because it is intended for home delivery. Codes 99431-99435, which include 99432, are used for services provided to a normal newborn. Code 99431 may be used in various settings, such as the delivery or birthing room, whereas, code 99432 is used in settings other than the delivery or birthing room, such as the newborn nursery. Many newborns, who are delivered without incident, do not have a doctor examine them until hours after their birth.
Therefore, the baby has already been taken to the newborn nursery, where the physician examines him/her.

Code 99433 (subsequent hospital care for the evaluation and management of a normal newborn, per day) is to be used when the newborn is examined each day after the initial history and examination (99431) and/or normal newborn care (99432). Code 99435 would only be used for newborns assessed and discharged from the hospital or birthing room on the same date. For discharge services that are provided on subsequent days of the delivery, use codes 99238 or 99239. For services provided to an ill infant in the hospital, use codes 99221-99223 for the initial visit and for subsequent visits, use 99231-99233. A critically ill newborn of very low birth weight (VLBW) is usually coded using the neonatal intensive care codes 99295-99298 per day.