Pediatric Coding Alert

Question: After suctioning the child for meconium (31515) at birth, the child goes on to have respiratory distress and you intubate to ventilate (31500). Are these codes bundled? How do you bill?

Franklin County Pediatric Associates
Chambersburg, PA

Answer: These are different procedures, done for different diagnoses. If you need to resuscitate the child at birth, you should use 99440 newborn resuscitation: provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output.

You also can bill emergency endotracheal intubation (31500) for the procedure done later. You may need a modifier -59 on the 31500 to show that it is a distinct procedure service. (Note that many newborns are resuscitated by positive pressure ventilation only and that 99440 does not cover intubation.)

Modifier -59 is of debatable value if your carrier doesnt recognize it: The modifier was created for breaking the bundles that are created by the Correct Coding Initiative, something that is essentially only for Medicare.

However, it is worth a try. If still denied, you should send documentation showing the sequence of events, with the aspiration occurring before the distress.