Pediatric Coding Alert

Question: Our provider spent about 30 minutes on stand-by for a scheduled cesarean delivery. The mom changed her mind about the C-section so our provider left. He was called back about two hours later because of fetal distress. The surgeon proceeded with a c-section. Our pediatrician was in attendance at the delivery and examined the baby; he didn't find any problems. He examined the baby for the next two days before the mom went home. How do we code this scenario?

Connecticut Subscriber

Answer: Start with 99464 (Attendance at delivery [when requested by the delivering physician] and initial stabilization of newborn) for the delivery. Then add 99460 (Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant) for the initial well newborn evaluation.

Report the next day's examination with 99462 (Subsequent hospital care, per day, for evaluation and management of normal newborn). Complete your claim with 99238 (Hospital discharge day management, 30 minutes or less) on the discharge day.

Checkpoint: You might need to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99460 on the first day. Although CPT guidelines do not specifically address needing modifier 25 in these situations, some insurance providers require the modifier.

Potential trap: Your physician provided 30 minutes of stand-by service, which you sometimes can code with 99360 (Physician standby service, requiring prolonged physician attendance, each 30 minutes [e.g., operative standby, standby for frozen section, for cesarean/high risk delivery, for monitoring EEG]). Parenthetical notes just below the descriptor, however, prohibit you from reporting 99360 with 99464, so you'll only report the attendance code.