Pediatric Coding Alert

Question: My pediatrician attends the birth of a 30-week gestation baby born in a small hospital. She resuscitates and intubates the infant and also inserts an umbilical catheter. The baby is then transported to a tertiary hospital. In addition to 99440 for resuscitation, 36600 for catheterization, and 31500 for intubation, what other codes should I use before the babys transport? Is 99295 appropriate or is this reserved for the neonatologist who receives the infant? Should I use 99289 instead?
 
Arizona Subscriber

Answer: Prior to the infants transport, your pediatrician should report the hospital admission with 99223 (Initial hospital care, per day, for the E/M of a patient ). If the pediatrician spends more than 30 minutes beyond the time designated in the E/M code, you should also report prolonged services. For face-to-face prolonged services lasting an hour beyond the usual service, use +99356 (Prolonged physician service in the inpatient setting, requiring direct [face-to-face] patient contact beyond the usual service ...; first hour ...). Report +99357 ( each additional 30 minutes ) for each additional half-hour of direct time.

The pediatrician may spend non-face-to-face time reviewing records and communicating with the family and the receiving neonatologist. For the first hour of nondirect physician services beyond the usual service, you should assign +99358 (Prolonged E/M service before and/or after direct [face-to-face] patient care [e.g., review of extensive records and tests, communication with other professionals and/or the patient/family]; first hour ...). Use +99359 ( each additional 30 minutes ) for each additional half-hour of nondirect time.

The hospital (99223) and prolonged service codes (99356-99359), unlike the neonatal critical care code (99295), do not include procedures such as the intubation (31500, Intubation, endotracheal, emergency procedure). Therefore, you should also report all performed procedures including intubation (31500), umbilical venous insertion (36510*, Catheterization of umbilical vein for diagnosis or therapy, newborn), arterial puncture (36600*, Arterial puncture, withdrawal of blood for diagnosis) and resuscitation (99440, Newborn resuscitation: provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output).

Note: Neonatal critical care (99295) includes intubation (31500), umbilical venous insertion (36510), and arterial puncture (36600) but not resuscitation (99440).

Using the initial hospital care codes (99221-99223) will allow the neonatologist to bill 99295 (Initial neonatal critical care, per day, for the E/M of a critically ill neonate, 30 days of age or less) without a duplication of services. Depending on the care provided, he may have to report 99295 appended with modifier -52 (Reduced services) to indicate reduced services. Do not use 99289 (Critical care services delivered by a physician, face-to-face, during an interfacility transport of critically ill or critically injured pediatric patient, 24 months of age or less; first 30-74 minutes of hands-on care during transport), unless the pediatrician accompanies the infant to the tertiary hospital.