Pediatric Coding Alert

Question: If a baby is not seen until the day after it is born, how should the pediatrician code when he or she discharges the infant?

New York Subscriber

 
Answer: If a baby is born at 10 a.m. and the pediatrician on rounds the next morning at 8 a.m. examines and discharges the infant, report 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]).
 
Some pediatricians like to perform the admission and discharge when they see the infant the day after birth so if the infant is released, they can bill 99435. However, if a problem arises, perhaps the baby develops a fever or the mother needs another day in the hospital, the physician reports 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]) and 99238 (Hospital discharge day management; 30 minutes or less). If the day(s) are billed correctly, this method is not fraudulent.