Wiki Newborn Well Baby Check

[mpar3ker]

When the child is born in the hospital and physician performs the well baby check (following Medicaid guidelines) is the coding of 99460 substantiate that exam? We had tried billing the 99381 in the hospital, but it kept getting denied due to place of service and the provider wants to know if that procedure code (99460) is stating that she is performing the well baby check?
In the CPT book it does say 99460 is for the evaluation and management of the newborn, including maternal/fetal history, newborn physical exam(s), ordering of diagnostic tests/treatments, meeting with the family, and documentation in the medical record. She doesn't get reimbursed the same as the actual codes for well child exams.

 

[Cynthia Hughes]

Code 99460 accurately describes the initial E/M service to the normal newborn and should be reported rather than the preventive medicine code that approximates the E/M and is appropriate to the well-child services provided after the initial hospital stay. Reimbursement should not impact code selection but you might note that the preventive medicine service provided in a facility setting has lower relative value units (RVUs) than the newborn E/M code. This would typically result in lower payment. Hope that is helpful.