Pediatric Coding Alert

Question: Prior to delivery, an obstetrician asked that one of our pediatricians be present for a high risk delivery. How should we code the exam when the pediatrician arrives just after the baby's birth?

Massachusetts Subscriber

Answer: If the pediatrician was in attendance at the delivery, report 99464 (Attendance at delivery [when requested by the delivering physician] and initial stabilization of newborn). If your physician was not in attendance at the delivery -- whether she missed it by seconds or hours -- you cannot code 99464. Instead, you should use 99460 (Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant).

Tip: When dealing with these types of cases, keep three things in mind: You must have a physician request for the pediatrician's service; the service must be medically necessary; and you can only report 99464 if the pediatrician is present at delivery.