Pediatric Coding Alert

Question: How can I bill for the time spent attending a delivery? The baby had Apgars of 8 and 9, but after the newborn admission and paperwork were completed, respiration worsened, oxygen saturation was 85 percent, the x-ray showed small pneumothoraces, and the baby went to the neonatal intensive care unit (NICU). In addition to 99436, should I bill 99431 even though the baby was not normal (after the exam), a hospital admit or prolonged services? The neonatologist will bill the NICU admission, but I was present for 90 minutes.

Pennsylvania Subscriber

Answer: If the baby was normal at the time of the examination, you should report 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.]). If the baby was sick at the time of the examination, report the initial hospital admission charge (99221-99223). Whether you use 99431 or 9922x, you also may report 99436 (Attendance at delivery [when requested by delivering physician] and initial stabilization of newborn). In addition, according to CPT, you should use prolonged services codes (99356, 99357) once you are 30 minutes beyond the time allowed in the hospital admission code.

Answers to You Be the Coder and Reader Questions were contributed by Richard H. Tuck, MD, FAAP, founding chairperson, American Academy of Pediatrics coding and reimbursement committee and a practicing pediatrician with PrimeCare Pediatrics in Zanesville, Ohio; Richard A. Molteni, MD, FAAP, medical director of Children's Hospital and Regional Medical Center in Seattle; and Paula Ziemski, CPC, PHR, of the University of Pittsburgh Medical Center.