Pediatric Coding Alert

Question: Our pediatrician performed a final hospital discharge for a newborn baby that lasted over 30 minutes, but when we submitted 99239 (Hospital discharge day management; more than 30 minutes) with Z00.110 (Health examination for newborn under 8 days old), we were denied. What is the correct ICD-10 code to submit with this service?

Colorado Subscriber

Answer: The issue here is the location of the visit when your pediatrician provided the service. When the baby was born, you would have reported a code from the Z38 series (Liveborn infants according to place of birth and type of delivery). The ICD-10-CM Official Guidelines for Coding and Reporting state that “A code from category Z38 is assigned only once, to a newborn at the time of birth. If a newborn is transferred to another institution, a code from category Z38 should not be used at the receiving hospital.”

In other words, as the American Academy of Pediatrics points out, you should “report Z38 as the primary code for each day the baby is in the birth hospital from birth. … It [the code] is used only once for the entire birth stay in the hospital of birth. Do not report a code from category Z00 for the baby’s stay in the hospital” (AAP News, Volume 36, Number 8. August 2015).

So, by reporting Z00.110, you indicated the baby had already been discharged, which does not support coding for a 99239 service. The Z38 code should remain in effect up until the discharge; after that, Z00.110 (or Z00.111 [Health examination for newborn 8 to 28 days old]); or Z00.12 [Health check, (routine) for child over 28 days old]) would be appropriate to submit with other procedural codes.

However, if a pediatrician needed to spend greater than 30 minutes in discharge due to an issue the neonate was having, use the reason for the longer discharge time — such as hyperbilirubinemia instead of the normal newborn diagnosis code. It will justify the use of the longer discharge code.