Pediatric Coding Alert

Question: A neonatologist is called into the delivery room for a consult on a newborn, and has to resuscitate the infant. How do you suggest coding this? Would we use the consult codes (99251-99255) with modifier -25 and 99440, or would we use the attendance at delivery code 99436 with 99440?

Delaware Subscriber

Answer: You cannot code for both 99436 (attendance at delivery [when requested by delivering physician] and initial stabilization of newborn) and 99440 (newborn resuscitation: provision of positive-pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output). In this case, if resuscitation (bag and mask positive-pressure ventilation) was required, use 99440.

If the consultation involves only attending the delivery, do not use an E/M services code only 99436 (no positive-pressure ventilation) or 99440 (positive- pressure ventilation). You cannot consult on a newborn until after the baby is born and resuscitated.

Answers to You Be the Coder and Reader Questions were provided by Thomas Kent, CPC, CMM, president of Kent Medical Management, a coding and practice management firm in Dunkirk, Md.; Victoria Jackson, chairwoman for the pediatric task force committee and MGMA administrator/CEO of the Southern Orange County Pediatric Associates in Lake Forest, Calif.; Richard H. Tuck, MD, FAAP, member of the AAP coding and reimbursement committee and a practicing pediatrician in Zanesville, Ohio; Mark S. Reuben, MD, FAAP, president of Reading Pediatrics, a private eight-pediatrician practice in Wyomissing, Pa.