Pediatric Coding Alert

Question: A patient with date of birth (DOB) 8/24/09 is now 47 days old. The baby was kept in the hospital for 42 days due to the mom being on Methodone; the baby was in withdrawal. How can we bill for a 42-day daily inhouse check? Should we bill per day? Or put in (40) X's units?

South Carolina Subscriber

Answer: You should code each day's care using two sets of codes: one for the newborn care (through the 28th day) and one for the infant care (29th day through the 41st day). If the newborn, especially in the early period, required intensive observation and frequent interventions, you Page 94 should code Initial and Continuing Intensive Care Services (99477-99480) on days 1-28. On day 1, you would use 99477 (Initial hospital care, for the evaluation and management of the neonate, 28 days of age or less, who requires intensive observation, frequent interventions, and other intensive care services).

Then, for days 2 though 28, choose the code based on the newborn's daily weight. You will probably use 99479 (Subsequent intensive care, per day, for the evaluation and management of the recovering low birth weight infant [present body weight of 1500-2500 grams]) and 99480 (Subsequent intensive care, per day, for the evaluation and management of the recovering infant [present body weight of 2501-5000 grams]).

For days 29 through 41, you'll assign the appropriate level of subsequent hospital care (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient ...).

Report the discharge based on the total time spent on the day's documented services. For discharge management taking 30 minutes or less, use 99238 (Hospital discharge day management; 30 minutes or less). If the pediatrician spent more than 30 minutes on these services, assign 99239 (... more than 30 minutes).

ICD-9 includes a newborn and infant code for withdrawal: 779.5 (Drug withdrawal syndrome in newborn). "Drug withdrawal syndrome in infant of dependent mother" also falls under 779.5.