Pediatric Coding Alert

Secret: Look to exam, discharge date - not birth date - when assigning 99435 Despite conflicting information on newborn care code 99435's applicable service date, you can report the code on day one or on a subsequent day.

After one coder requested clarification regarding 99435's descriptor, Pediatric Coding Alert discovered that the history-and-exam code confused even experts. Here's the lowdown on what this code means. Coding Sources Contradict Each Other If you've tried to answer 99435's date dilemma, you may point to sources that restrict the code to a birthday discharge or expand it to include additional days. In fact, experts cited contradictory information in response to the following scenario:

Case study: A baby is born in the hospital on day one. On day two, when the pediatrician sees the infant for the first time, she performs a history, exam and physical. She then discharges the newborn.

Question: "Should I submit the encounter with 99431 (newborn exam) and 99238-99239 (discharge) or 99435?" asks Charlotte T. Tweed, CPC, coder at Hospital Florida in Orlando. Grab your CPT and Coding for Pediatrics manuals and see if you know how to code her scenario before reading on. CPT Implies Both Perhaps you looked in CPT and found documentation that leads you to code the above encounter as 99431 (History and examination of the normal newborn infant, initiation of diagnostic and treatment programs and preparation of hospital records [this code should also be used for birthing room deliveries]) and 99238-99239 (Hospital discharge day management; 30 minutes or less; ... more than 30 minutes). If you did, you're not alone.

Why: You could use CPT's E/M section to bolster your view that you should report 99435 (History and examination of the normal newborn infant, including the preparation of medical records [this code should only be used for newborns assessed and discharged from the hospital or birthing room on the same date])only when a newborn goes home on his birthday.
 
Under "Newborn Care," the third paragraph states you should use 99435 for newborns "admitted and discharged on the same date," says Diane M. Minard, CPC, pediatrics coding adviser for Children's Hospital at Dartmouth in Lebanon, N.H.

The admission date is the date-of-birth. Therefore, CPT's sentence implies that you should report 99435 only for babies whom the pediatrician discharges on their date-of-birth, Minard reasons.

Conflict: The same CPT section also suggests that you could use the code on a following date, such as day two. Code 99435's description says "assessed and discharged on the same date," Minard says.

The phrase suggests that only the assessment and discharge must occur on the same date - not the admission. So if, as in the example, a pediatrician didn't see a newborn until day two, on [...]