Pediatric Coding Alert

Question: One of our pediatricians examined a newborn for the first time on the date of birth and billed 99460. The day after, another pediatrician from a different practice also evaluated the baby. Does this second pediatrician get to bill 99460 again, given that this is the first time this pediatrician is seeing the baby? Or does the second pediatrician bill a subsequent visit?

APC Forum Participant

Answer: In this situation, the first pediatrician would be correct in billing 99460 (Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant) for the initial evaluation, assuming the child is born free of any medical conditions requiring care above and beyond that needed for a normal newborn.

However, the second pediatrician would be incorrect in billing the encounter on the following day with the same code. The code is reserved for the first, initial day of care only for the same recipient, regardless of provider, and most payers will only reimburse 99460 once for that recipient. Instead, the second pediatrician should bill 99462 (Subsequent hospital care, per day, for evaluation and management of normal newborn) for the second and any other subsequent day of normal newborn care up to the day of discharge.