Pediatric Coding Alert

Question: A pediatrician cannot determine a newborn's gender. The physician contacts an endocrinologist and a geneticist and spends a lot of time with the parents. Later in the day, the newborn develops sepsis. The physician re-examines the baby, orders a workup, talks to the parents again, etc. The pediatrician spends more than three hours in total on the case. Would the scenario qualify for 99477?

Illinois Subscriber

Answer: Because the infant develops sepsis (771.81, Septicemia [sepsis] of newborn), you should report the day's E/Ms as 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).

An infant who develops sepsis requires intensive observation and will typically qualify for 99477. The condition, as you describe, requires workup, re-evaluating the infant's status, and parental discussion.

Physicians often provide initial intensive neonatal care in the neonatal intensive care unit (NICU). But because 99477 is not site-specific, the pediatrician may provide this care outside of an NICU.

Beware: If the infant had not developed sepsis, you would have coded the gender-issue E/M services with an initial hospital care code (such as 99222 or 99223, Initial hospital care, per day, for the evaluation and management of a patient ...). The gender issue alone would not require frequent observations and monitoring and would not qualify as 99477.