Pediatric Coding Alert

Question: Our pediatrician performed a normal newborn well-child service on a child who had been born at home and who had received no prenatal care. The pediatrician performed all of the services that would typically be performed on a normal newborn right after birth — a newborn blood draw, hearing screen, Hepatitis B vaccine, and a vitamin K injection. In addition to the well-child check, should I code an additional evaluation and management service (E/M) for the other services? And should I use P00.89 for the diagnosis, given that the child received no prenatal care?

Alabama Subscriber

Answer: For the services, you can report the well-child check with 99461 (Initial care, per day, for evaluation and management of normal newborn infant seen in other than hospital or birthing center). But you do not need to code for an additional E/M service. Instead, you would code for the newborn procedures you mention, including:

• 92558 (Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis);
• S3620 (Newborn metabolic screening panel, includes test kit, postage and the laboratory tests specified by the state for inclusion in this panel (e.g., galactose; hemoglobin, electrophoresis; hydroxyprogesterone, 17-D; phenylanine (PKU); and thyroxine, total));
• 90744 (Hepatitis B vaccine (HepB), pediatric/adolescent dosage, 3 dose schedule, for intramuscular use) using 90471 (Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)) for the administration; and
• J3430 (Injection, phytonadione (vitamin K), per 1 mg), using 96372 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular) for the administration.

You would also add modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to 99461 to indicate that the E/M service was separate from the other procedures.

For the diagnosis, you should only code what your pediatrician has diagnosed. The P00.89 (Newborn affected by other maternal conditions) code would not be appropriate because, even though the child did not receive prenatal care, your pediatrician has not indicated that the lack of care affected the child. Instead, Z38.1 (Single liveborn infant, born outside hospital) is all you need to justify the 99461.