Pediatric Coding Alert

Answer: This is not a simple question. Technically, the answer is that you should bill 99440 (newborn resuscitation: provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output). You use this code even if the resuscitation is not successful. Work, not success of the procedure, is the determinant of the code.

But there is a problem if the baby is stillborn: There is no patient, and no insurance card. If the baby only lives a short while, thats a different story. Then there is a patient, with a name and number to bill. In many hospitals, the obstetrician (ob) will not call the pediatrician if a baby is stillborn. But the ob occasionally insists, for his or her own liability reasons, that resuscitation be attempted. The most practical solution is to bill the visit not as 99440 but as a consultation to the ob (99251-99255), billing the mothers account. You also can bill 99440 to the mothers account if you have performed resuscitation.

You will need to write a note to the insurance company explaining that you were asked to consult and that the baby was resuscitated but never lived. Some hospitals routinely write off these services, but that isnt fair to the pediatrician who needs to be reimbursed and who shouldnt have to lose revenue because of others liability concerns. Insurance companies are not unreasonable in cases like this. As long as you write a note, and dont try to file it electronically like a routine case, you should not have trouble getting paid.

Sources for answer: Richard A. Molteni, MD, FAAP, CPT editorial panel member, Charles M. Vanchiere, MD, FAAP, chair of the AAPs committee on coding and reimbursement, and A.D. Jacobson, MD, FAAP, editor of the AAPs Coding for Pediatrics.