Pediatric Coding Alert

New resuscitation code stresses separate site.

If your neonatal group is plagued with newborn resuscitation bundles, a location indicator included in the new resuscitation code could signal the end of an era.

"We are having problems getting 99440 paid when performed in the delivery room with an admit-to-NICU code of 99295, even with documentation," says Pamela J. Dirickson, with CoxHealth's Neonatology Physicians in Springfield, Mo. When a physician provides medically necessary resuscitation in the delivery room, insurers don't understand that CPT allows you to separately bill 99440 in addition to 99295 (Initial inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or less ...) (becomes 99468 in 2009).

However, a change in the verbiage of 99400 (Newborn resuscitation: provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output) will highlight the resuscitation's separate site.

Change Emphasizes Locations
 
When the resuscitation code makes its 2009 renumbered debut, it will appear as 99465, rather than 99440. Instead of referring to "newborn resuscitation," 99465 will specify "delivery/birthing room" resuscitation: provision of positive-pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output.

Benefit: The new revised wording will make appealing a bundling denial much easier, says Donnelle Holle, RN, who recalls having the same experience while Director of Professional Billing for the Department of Pediatrics at the University of Michigan. "With the new statement of 'delivery/birthing room,' the practice will be able to demonstrate to the carriers that in fact the resuscitation was not performed in the neonatal intensive care unit (NICU)."

You should appeal bundling policies with a copy of the new wording, plus the "Inpatient Neonatal and Pediatric Critical Care" introductory notes. "These state that 99295 can be billed in conjunction with 99464 (attendance of delivery) or 99465 (newborn resuscitation)," says Holle, who is now a coding and reimbursement consultant with Pedscoding Inc. in Fort Wayne, Ind.

"The physicians need to remember that they cannot bill both 99464 and 99465 at the same time," Holle says. Code 99465 includes 99464.

Add Intubation When Also Required

You can report pre-admission delivery procedures that the baby requires in addition to resuscitation. The new text for 99465 and the neonatal and pediatric critical care notes specify that procedures performed as a part of the resuscitation (such as intubation) and not simply as a convenience before admission to the neonatal intensive care unit are reported separately, as well, Holle points out.

Endotracheal intubation (31500) performed in the NICU is bundled into 99295 (2009: 99468) and 99440 (2009: 99465).

Adhere to 99465-99477 Edit

Make sure you don't bill 99465 (old 99440) in conjunction with 99477, Holle adds. "Code 99477 is to be used when an infant is ill but not 'critical.'"

If you have to do a full-blown resuscitation, the infant is considered critically ill. Therefore, 99477 would not be appropriate.