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.

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.

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."

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.

No mother-to-be dreams of delivering a baby in a taxi. But if your physician performs the initial history and examination in a location other than a hospital or birthing center, use the code for normal newborn infant seen in other than hospital or birthing center.

Action: Find 99432 in your system or charge ticket and replace it with the 2009 version: 99461 (Initial care, per day, for evaluation and management of normal newborn infant seen in other than hospital or birthing center).

When a normal newborn remains in the hospital after the first day the physician performs the initial history and examination, you should report subsequent hospital care.

In 2008, you used 99433. Your new code for 2009 is 99462 (Subsequent hospital care, per day, for evaluation and management of normal newborn).

You could incorrectly code discharge services if you don't pay attention to the admit and discharge date(s) and the discharge's documented time. Follow these principles to code correctly.

1. When a physician admits the newborn to the hospital and discharges him on the same date, report only one code for both services.

Example: A newborn is born at 10 am on Saturday. An FP examines the newborn on rounds and leaves a discharge order with the nursing staff that the infant can go home with mom that evening, provided the newborn remains well.

You would report 99435 for claims with dates of service before Jan. 1, 2009, and thereafter use 99463 (Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant admitted and discharged on the same date). The code pays about the same as individually coding the services.

"You can only code discharge services on the date the physician sees the patient face-to-face," stressed Peter A. Hollman, MD, medical director for Blue Cross Blue Shield of Rhode Island, at the AMA CPT conference.

2. Code out the discharge based on documented time for separate date face-to-face admission and discharge. The discharge time is the sum of all time spent performing discharge-related services and does not have to be continuous, Hollman added.

Suppose the physician in the above normal newborn care example saw the newborn face-to-face on Sunday and performed the discharge services on that day. You would code initial hospital care for day 1 and regular discharge codes for day 2. In 2009, the claim would include 99460 and 99238 (Hospital discharge day management; 30 minutes or less) or 99239 (- more than 30 minutes) for discharge services, depending on how much time the physician spends in discharge services.