Pediatric Coding Alert

Question: An ob-gyn called our pediatrician into the delivery room for a consult, and the pediatrician had to resuscitate the newborn. How do you suggest coding this? Should we use the consult codes (99251-99255) with modifier 25 appended along with 99440, or should we use the attendance-at-delivery code 99436 with 99440?


Arizona Subscriber
Answer: Insurers will not reimburse 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) during the same session.

CPT specifically states, "Do not report 99436 in conjunction with 99440." Therefore, you should always bill 99440 when you perform both delivery-room attendance and resuscitation. The work of attending a delivery is included in the relative value of 99440, which has a significantly higher payment than 99436.

In this case, if the pediatrician used resuscitation (bag and mask positive-pressure ventilation) you should report 99440. If the "consultation" you refer to was simply a request to attend the delivery, the pediatrician should not report any E/M services. If the physician performed resuscitation without positive pressure ventilation, you should report 99436 instead of 99440.