Pediatric Coding Alert

If a normal newborn becomes sick on day one following the initial exam, you can still report 99477 even though this would be the day's second E/M.

You can report a normal newborn code with a sick newborn code on the same day (99477, 99295, 99221) when the infant becomes sick later that day, says Richard Molteni, MD, a neonatologist at Children's Hospital & Regional Medical Center in Seattle and an AMA CPT advisory committee member. Good news: The next CPT book (2009) will confirm that.

Example: A physician evaluates a normal newborn after an uneventful delivery and reports 99431 (History and examination of the normal newborn infant, initiation of diagnostic and treatment programs and preparation of hospital records. [This code should also be used for birthing room deliveries]). "Later in the day, the infant develops respiratory distress and is transferred to an intensive setting for observation, frequent interventions, continual cardiorespiratory monitoring, and other intensive care services," according to CPT Assistant, Jan. 2008. "The physician sees the child again and initiates intensive care services."

Because the physician in the previous example provides two distinct services on the same day, the AMA instructs to code this example as:

• 99431 appended with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service)

• 99477 (Initial hospital care, per day, 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).