Some Tricky Questions and Answers About Treating Newborns
Published on Sun Mar 01, 1998
High-risk deliveries can mean a lot of waiting around for pediatricians. The physician is almost always summoned to the delivery, they may do an extensive amount of work once the baby is born, or they may do nothing more than stabilization.
Thomas J. Catalanotto, MD, administrator of Pediatric Associates of Fairfield in Fairfield, OH, is a subscriber who has submitted to PCA three vexing reimbursement challenges from his practice. Catalanotto specializes in high-risk coverage at a level 2 neonatal center. The response comments are provided by Richard H. Tuck, MD, FAAP, an AAP coding trainer and a practicing pediatrician in Zanesville, OH.
Scenario #1: I am called to attend delivery because of thick particulate meconium. I am requested to arrive at 9:30 pm, which I do. The infant is finally delivered at 11:30 pm. There is particulate meconium. The infant is intubated two times and thick particulate meconium is suctioned from the trachea. The patient is subsequently perfectly fine, requires no oxygen or IV fluids, is placed in the special care nursery for observation, and goes out to mom within an hour.
I usually code this situation in the following way: 99436 -- Attendance at delivery when requested by the delivering physician, and stabilization of the newborn; CPT 31520 -- Laryngoscopy/intubation and suctioning of the newborn; 99431 -- Care of the normal newborn.
Comment: Tuck agrees with using 99436 and 99431. However, he does not think 31520 is the appropriate code for dealing with intubation and aspirated meconium. What he did was intubate the infant, he says. I suggest using 31500. The descriptor for 31500 is Intubation, endotracheal, emergency procedure. The descriptor for 31520 is Laryngoscopy direct, with or without tracheoscopy; diagnostic, newborn.
(Tip: Remember, when CPT has indented codes, you should go to the top code and insert the indented descriptor after the semi-colon in the descriptor on the top, unindented code.)
In this situation the pediatrician is not doing a diagnostic procedure; he was intubating. The code immediately preceding 31520 -- which is 31515 -- might be appropriate also under slightly different circumstances. The descriptor for 31515 is Laryngoscopy direct, with or without tracheoscopy; for aspiration. If the infant had not required intubation, 31515 should have been used, says Tuck. If he just looked and aspirated, he should use 31515.
(Note: So when would Tuck use 31520? We dont, he says. Its more for pediatric ENTs, when they have to do a diagnostic laryngoscopy on a newborn.)
Scenario #2: I am called by the OB to attend the delivery of a premature 30-week infant. I arrive at 7 am. Delivery takes place at 8 am. The infant is a 29 weeker, approximately 2 pounds. The baby requires resuscitation at delivery [...]
