Primary Care Coding Alert

Massive changes bring children's E/M coding system together. Overhauling your total newborn care for 2009 will cost you some time and money but you can ease the transition with this step-by-step guide. Getting through the initial mental and financial shift should be worth it. "Re-creating the newborn care coding system gave us the ability to coordinate codes that were causing confusion," explained Richard Molteni, MD, in "Pediatric Revisions: 2009 CPT Changes" at the CPT and RBRVS 2009 Annual Symposium on Nov. 12-14 in Chicago. Step 1: Recognize Solitary Preserved Code You may not have used initial intensive care code 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) very often, but this is the code that triggered the revolution and the only code that remains the same. When CPT 2008 introduced 99477, the system had no location to place the code within the pediatric codes. The code had to be placed in the "Other Evaluation and Management Services" subsection. Problem: Code 99477's placement created an anomaly, recalls Molteni, who is the AMA CPT Advisor for the American Academy of Pediatrics and a neonatalogist. Placing initial intensive care at the end of the E/M series meant you had to flip through the CPT manual with normal newborn care in one place, transport in another, neonatal in another, and initial intensive care at the end. Step 2: Look for Newborn Care in 99460s CPT 2009 renumbers normal newborn care. You will have four new codes. Starting Jan. 1, 2009, you will report 99431-99440 with new codes 99460-99465. Relocating all the codes in the series and moving all the normal newborn care codes to the 99460 series allowed CPT to bring these areas together, Molteni explains. "The new system now really follows a clear clinical pattern -- normal newborn, resuscitation, transport, critical care, intensive care -- that's easy to follow." Step 3: Replace Normal Code 99431 With 99460 You can replace commonly-used normal newborn code 99431 with 99460 (Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant). This code is for the physician performing an initial history and examination in the hospital or birthing center on a normal newborn who has no other diagnosis than a normal newborn V code, says Donelle Holle, RN, coding and reimbursement consultant with Pedscoding Inc. in Fort Wayne, Ind. If you report 99460 with any diagnosis other than a normal newborn V code, such as V30.00 (Single liveborn; born in hospital; delivered without mention of cesarean delivery), expect a denial. Step 4: Choose 99461 for Other Site Initial Care No [...]