Wiki Normal Newborn - NICU Transfer

[Brittany.Crafts@Providence.org]

I have a situation I'm not sure how to code for. My provider is a Family Medicine/OB Provider, she delivered a new baby on Sunday and did the Newborn H&P, so I billed a 99460.

First issue:
Later that same day, the newborn became ill and my provider transferred/admitted him into the NICU. My thought for this charge would be 99477 (initial) or 99480 (subsequent, by weight). I'm leaning more towards 99480, because I don't know if I can bill for two initial charges in the same day, even though they were different departments?

Second issue:
The next day, my provider saw the patient in the NICU and provided care, then transferred care to the neonate provider in the NICU. I'm thinking 99480 for this encounter as well.

Thoughts? I was reading some old threads and it said that the 99477 series is only to be reported by the neonatologist in the NICU, and that we should use the 99231 series, but in the notes sections in my CPT book, it says that neonate services should be billed with the 99477 codes, so now I am thoroughly confused. Help!

 

[LINDA]

Normal Newborn - NICU transfer

For the first question, you can bill both 99460 and 99477 on the same day. CPT allows you to bill for an initial visit for a normal newborn and then another initial visit for an initial intensive care visit. (rare exception to the rule of combining servcies on the same day) You would most likely need to use modifier 25 just to explain to the payer that these are significant / separate services and both services would need separate documentation.

As for the day of transfer to the Neonatologist, only 1 provider can bill the global NICU visit (99480) on the same calendar day. When care is transferred, the rule is that the receiving provider gets to bill the global NICU charge (99480). The transferring physician would bill the appropriate standard hospital E/M code (99221-99233) or the hourly critical care, whichever is appropriate.