Pediatric Coding Alert

Question: A baby was born in the hospital on 6/1. On 6/2, our pediatrician performed the initial newborn care and then discharged the child on the same day. Do we bill 99460 and 99238 together for the same day? Or should we bill 99463 even though our pediatrician did not visit the newborn on the day of admission?

AAPC Forum Participant

Answer: When hospital admissions and initial visits occur on different days, you should base your pediatrician’s initial care date on when your pediatrician first saw the patient, not on the hospital initial care date. As that first face-to-face encounter with the patient also happened to be on the same date of discharge, 99463 (Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant admitted and discharged on the same date) is the most appropriate code to use when billing for this encounter. And, as 99463 includes the same-day discharge, you would not code 99238 (Hospital discharge day management; 30 minutes or less) separately.

And remember: When billing this code, your pediatrician must document services and not just the initial newborn visit. They should include the assessment and a plan for further care after discharge including visits, medications, labs, and other services as appropriate.