Wiki Question Subsequent Days - newborns in hospital

[gigiduffy]

Question Subsequent Days - newborns in hospital

This issue is screaming at me - the CPT manual stats that the Z38 code is to be used only on the initial birth record. Are subsequent visits considered to be part of the birth record since they are part of the same hospital confinement? If I use the Z00.110 for the subsequent days visits or the discharge visit on a 99460 or the discharge code, is this more correct. The initial birth record verbiage in the CPT book is what is throwing me for a loop. Any assistance would be greatly appreciated. I may have raised a red flag on this for nothing, and I do not want to have egg on my face.

 

[samdvs39]

when I bill out subsequent visits I still use the z38 code. I only use the z00 code when they first come and see a pediatrician for their first well visit.

 

[Linda77]

I second that.

 

[kaywil2]

Discharge infant from birth

What about an infant that has been in the hospital since birth and is over 28 days old at discharge and the problems it had as a newborn has resolved?
I am having difficulty coding the diagnosis for this and the provider only documented the conditions with Resolved after them. Are we not supposed to code anything that is not active? Please help!

 

[dwhomeschool@yahoo.com]

Also need help! Please

Question Subsequent Days - newborns in hospital

This issue is screaming at me - the CPT manual stats that the Z38 code is to be used only on the initial birth record. Are subsequent visits considered to be part of the birth record since they are part of the same hospital confinement? If I use the Z00.110 for the subsequent days visits or the discharge visit on a 99460 or the discharge code, is this more correct. The initial birth record verbiage in the CPT book is what is throwing me for a loop. Any assistance would be greatly appreciated. I may have raised a red flag on this for nothing, and I do not want to have egg on my face.

I am also having issues with this questions. When I first started coding newborns on subsequent visits we were also coding the z38.00 or z38.01. Problem is, we started receiving denials. My manager asked me to start using the z00.110-z00129 codes. I'm not sure this is correct either because when you read it seems to be for office visits. Any help is appreciated.

 

[Cynthia Hughes]

Z38 for birth admission

I am also having issues with this questions. When I first started coding newborns on subsequent visits we were also coding the z38.00 or z38.01. Problem is, we started receiving denials. My manager asked me to start using the z00.110-z00129 codes. I'm not sure this is correct either because when you read it seems to be for office visits. Any help is appreciated.

This Q & A from Coding Clinic 2017 is about ill neonates but the advice that you may continue to use Z38 through to discharge (attending physician only) should still be applied. A payer may require may require Z00.110-Z00.111 when counting the visits as preventive services but this would be reported secondary to the Z38 code.

Question:

Occasionally newborns are admitted to our facility from birth, and stay well beyond the 29th day of life due to perinatal or congenital conditions. For reporting the attending physician services, is it appropriate to assign a code from subcategory Z38.0-, Single liveborn infant, born in hospital, regardless of the length of stay and age of the patient?

Answer:

Yes, it is appropriate to assign a code from subcategory Z38.0-, Single liveborn infant, born in hospital, as the first-listed diagnosis for the attending physician services until the patient is discharged from the birth hospital. Coding Clinic, Second Quarter 2015, page 15, stated, “For physician coding and reporting, category Z38 codes are not limited to only the day the baby was born. A physician may report a code from category Z38 for each visit during the birth admission.

Hope this is helpful.
Cindy

 

[tlwright70]

In regards to the subsequent visit and discharge for newborns coding the Z38.00 or Z38.01 is correct for the birth, but the Z00 would be used for the subsequent and discharge. I have the pediatric study guide for the test and an example of this is in it.

 

[Tami_F]

I am also having issues with this questions. When I first started coding newborns on subsequent visits we were also coding the z38.00 or z38.01. Problem is, we started receiving denials. My manager asked me to start using the z00.110-z00129 codes. I'm not sure this is correct either because when you read it seems to be for office visits. Any help is appreciated.

Check your guidelines. This is from the first page: "The term encounter is used for all settings, including hospital admissions."

In regards to the subsequent visit and discharge for newborns coding the Z38.00 or Z38.01 is correct for the birth, but the Z00 would be used for the subsequent and discharge. I have the pediatric study guide for the test and an example of this is in it.

Thank you!!

For reference, the case study is a "pediatrics well newborn inpatient discharge note," and the question asks for the ICD-10 code. The rationale points to the guideline below, and also states: "Since this exam is occurring two days after the birth, the correct code would be Z00.110 Health examination for newborn under 8 days old."

ICD-10-CM Official Guidelines for Coding and Reporting 2018, I.C.16.a.2:
Principal Diagnosis for Birth Record
When coding the birth episode in a newborn record, assign a code from category Z38, Liveborn infants according to place of birth and type of delivery, as the principal diagnosis. A code from category Z38 is assigned only once, to a newborn at the time of birth. If a newborn is transferred to another institution, a code from category Z38 should not be used at the receiving hospital.​

I've been going back and forth on this tonight, because there are two Q&As from the AHA Coding Clinic (2015 Q2, pg 15; and 2017 Q2, pgs 5-6) that seem to contradict the guideline above. The official guidelines take precedence over any other information or interpretations. This guideline doesn't appear to have changed since this question was first posed, and it explicitly states that a Z38 code should be "assigned only once".

Z38 should be used one time, period, regardless of how long the patient is admitted. For a well newborn, report a Z38 code as primary on the initial day, and a Z00 code on subsequent or discharge days. For unwell newborns, code the conditions that are being treated. I can't imagine a scenario where a patient would continue to be admitted (for 28+ days!) where there wouldn't be a more appropriate primary diagnosis to code.

 

[Cynthia Hughes]

Z38 for birth admission

Per below, Coding Clinic 2015 noted that the guidance was for physician reporting. The one-time reporting of Z38 is in reference to hospital reporting which is for the whole (single) birth admission. I know AAPC had directed otherwise regarding this but it is clearly correct for the attending physician(s) to report Z38 for all visits within the birth admission. This misinterpretation regarding one-time reporting goes back to ICD-9 and unfortunately continues in ICD-10. The V20 preventive service codes were expanded to include neonatal codes in 2009 (requested specifically for post-discharge visits because some neonates were going home within 24 hours of birth and initial preventive care within 3-5 days of discharge was recommended to evaluate for jaundice or other problems that may develop within the first days of life). Some then applied the instruction regarding one time reporting of the V30 codes that has existed since 2002 to address newborn transfers (birth hospital to other hospital) to all visits after the day of birth. Coding Clinic clearly addressed this misunderstanding in 2015.

Coding Clinic advice should be followed by physicians and payers under HIPAA so it would be good to document advice from payers that directs otherwise. Cindy

Check your guidelines. This is from the first page: "The term encounter is used for all settings, including hospital admissions."




Thank you!!

For reference, the case study is a "pediatrics well newborn inpatient discharge note," and the question asks for the ICD-10 code. The rationale points to the guideline below, and also states: "Since this exam is occurring two days after the birth, the correct code would be Z00.110 Health examination for newborn under 8 days old."

ICD-10-CM Official Guidelines for Coding and Reporting 2018, I.C.16.a.2:
Principal Diagnosis for Birth Record
When coding the birth episode in a newborn record, assign a code from category Z38, Liveborn infants according to place of birth and type of delivery, as the principal diagnosis. A code from category Z38 is assigned only once, to a newborn at the time of birth. If a newborn is transferred to another institution, a code from category Z38 should not be used at the receiving hospital.​

I've been going back and forth on this tonight, because there are two Q&As from the AHA Coding Clinic (2015 Q2, pg 15; and 2017 Q2, pgs 5-6) that seem to contradict the guideline above. The official guidelines take precedence over any other information or interpretations. This guideline doesn't appear to have changed since this question was first posed, and it explicitly states that a Z38 code should be "assigned only once".

Z38 should be used one time, period, regardless of how long the patient is admitted. For a well newborn, report a Z38 code as primary on the initial day, and a Z00 code on subsequent or discharge days. For unwell newborns, code the conditions that are being treated. I can't imagine a scenario where a patient would continue to be admitted (for 28+ days!) where there wouldn't be a more appropriate primary diagnosis to code.

 

[Tami_F]

We're still having this conversation (on and off), hooray! We are also getting denials.

My supervisor just brought this to my attention, and I'm curious what you think, Cynthia.

Reporting of neonatologist services
ICD-10-CM/PCS Coding Clinic, Second Quarter ICD-10 2017 Pages: 6-7 Effective with discharges: May 17, 2017

I'm hesitant to post the full Q & A without consent from the AHA.

Personally, I'm not sure this clarifies much, as the answer states that the neonatologist is not the attending. Generally, at least where I work, the neonatologist is the attending. Also, the question states that the patient was transferred to the NICU - who else would be the attending if not the neonatologist?

 

[Cynthia Hughes]

I think the only way to overcome denials and/or confidently code your claims is to contact the individual health plans to discuss the reason for the denials and point them to the AHA Coding Clinic article from 2017 titled "Newborn Coding and Reporting of Attending Physician Services." It could not more clearly state that category Z38 codes are not limited to the day the baby was born and the attending physician may report the Z38 code for each visit during the birth admission. Additionally, the guidelines include Z38 on the list of codes used only as the principal/first-listed diagnosis. Coding Clinic and the official guidelines for ICD-10-CM are HIPAA-compliant coding guidance.

The article you mention, "Reporting of Neonatologist Services" is specific to an infant that was transferred to a new facility (ie, started a new admission after the birth admission). The neonatologist is the attending physician at the second hospital and does not report a code from Z38 (nor does the second hospital).

If an issue arises where a payer is not recognizing correct code assignment, there is an avenue to file a HIPAA complaint to CMS at https://asett.cms.gov/ASETT_HomePage. I would use this only in a case where there was no ability to reach a solution with a specific health plan.

Cindy

 

[Tami_F]

Cindy, thanks so much for your ongoing help with this. I will share your advice with my supervisor.

Actually, the question in the "Reporting of Neonatologist Services" states in part, "The baby was resuscitated, and transferred to the neonatal intensive care unit (NICU) at the same hospital." (emphasis mine)

The answer states in part, "It is not appropriate for the neonatologist to report a code from subcategory Z38.0-, Single liveborn infant, born in hospital, since he/she is not the attending physician and is following the newborn for a specific diagnosis or problem." (emphasis mine)

Part of the reason I've been wrestling with this issue for so long is that, coding NICU babies who have serious, life-threatening issues, it just doesn't make sense to me that the Z38 code would be relevant past the first day of life, if even then. If the pt has organ failure, which would definitely qualify as "a specific diagnosis or problem," that seems more important, and like it should be the primary dx code used. The primary dx code used should be the reason the pt is being seen, right? Logically, then, if a baby is in the NICU for three months because of organ failure, that organ failure would be the most relevant dx code, as it would be the reason for ongoing care and admission to the hospital.

I could see it making sense to continue using a Z38 code as the primary dx for a normal newborn who is well and will be discharged within the first few days of life. A normal newborn doesn't have an active diagnosis that is being treated. A baby in the NICU on the other hand, absolutely will have at least one specific dx that requires an ICU level of care and monitoring.

The other issue I have a hard time with is the requirement that Z38 be the primary dx code. I just can't see the circumstances of the baby's birth being more important than the actual issues being treated by the neonatologists, especially after the baby has been admitted to the NICU for a substantial period of time.

I think the only way to overcome denials and/or confidently code your claims is to contact the individual health plans to discuss the reason for the denials and point them to the AHA Coding Clinic article from 2017 titled "Newborn Coding and Reporting of Attending Physician Services." It could not more clearly state that category Z38 codes are not limited to the day the baby was born and the attending physician may report the Z38 code for each visit during the birth admission. Additionally, the guidelines include Z38 on the list of codes used only as the principal/first-listed diagnosis. Coding Clinic and the official guidelines for ICD-10-CM are HIPAA-compliant coding guidance.

The article you mention, "Reporting of Neonatologist Services" is specific to an infant that was transferred to a new facility (ie, started a new admission after the birth admission). The neonatologist is the attending physician at the second hospital and does not report a code from Z38 (nor does the second hospital).

If an issue arises where a payer is not recognizing correct code assignment, there is an avenue to file a HIPAA complaint to CMS at https://asett.cms.gov/ASETT_HomePage. I would use this only in a case where there was no ability to reach a solution with a specific health plan.

Cindy

 

[Cynthia Hughes]

Cindy, thanks so much for your ongoing help with this. I will share your advice with my supervisor.

Actually, the question in the "Reporting of Neonatologist Services" states in part, "The baby was resuscitated, and transferred to the neonatal intensive care unit (NICU) at the same hospital." (emphasis mine)

The answer states in part, "It is not appropriate for the neonatologist to report a code from subcategory Z38.0-, Single liveborn infant, born in hospital, since he/she is not the attending physician and is following the newborn for a specific diagnosis or problem." (emphasis mine)

Part of the reason I've been wrestling with this issue for so long is that, coding NICU babies who have serious, life-threatening issues, it just doesn't make sense to me that the Z38 code would be relevant past the first day of life, if even then. If the pt has organ failure, which would definitely qualify as "a specific diagnosis or problem," that seems more important, and like it should be the primary dx code used. The primary dx code used should be the reason the pt is being seen, right? Logically, then, if a baby is in the NICU for three months because of organ failure, that organ failure would be the most relevant dx code, as it would be the reason for ongoing care and admission to the hospital.

I could see it making sense to continue using a Z38 code as the primary dx for a normal newborn who is well and will be discharged within the first few days of life. A normal newborn doesn't have an active diagnosis that is being treated. A baby in the NICU on the other hand, absolutely will have at least one specific dx that requires an ICU level of care and monitoring.

The other issue I have a hard time with is the requirement that Z38 be the primary dx code. I just can't see the circumstances of the baby's birth being more important than the actual issues being treated by the neonatologists, especially after the baby has been admitted to the NICU for a substantial period of time.

Sorry about that, I had found only one of two Coding Clinic articles from that issue when I looked in my online coding software previously. I found the article you mention but the question implies the neonatologist is not the attending by stating, "The neonatologist was responsible for care of the baby’s respiratory problems in the NICU." I can only guess that perhaps the question focused on a neonatal pulmonologist rather than a general neonatologist.

I agree with your logic but the coding guidelines often seem most focused on facility reporting for the total stay and the identification of the birth admission versus a subsequent admission. I truly wish there were completely separate guidelines for professional and facility services and separate Coding Clinic advice as well.
Cindy

 

[Tami_F]

Sorry about that, I had found only one of two Coding Clinic articles from that issue when I looked in my online coding software previously. I found the article you mention but the question implies the neonatologist is not the attending by stating, "The neonatologist was responsible for care of the baby’s respiratory problems in the NICU." I can only guess that perhaps the question focused on a neonatal pulmonologist rather than a general neonatologist.

I agree with your logic but the coding guidelines often seem most focused on facility reporting for the total stay and the identification of the birth admission versus a subsequent admission. I truly wish there were completely separate guidelines for professional and facility services and separate Coding Clinic advice as well.
Cindy

Thank you. Separate guidelines sound wonderful, but I won't hold my breath.