CODING 1 0 1 Charles T. Hankins, MD. Coding for Neonatal-Perinatal Medicine 1.A neonatologist is...

CODING CODING 1 0 11 0 1

Charles T. Hankins, MDCharles T. Hankins, MD

Coding for Neonatal-Perinatal MedicineCoding for Neonatal-Perinatal Medicine

1.1. A neonatologist is asked to attend a repeat c-A neonatologist is asked to attend a repeat c-section. The infant is born with Apgar scores of section. The infant is born with Apgar scores of 8, 9. No resuscitation is necessary. Child goes 8, 9. No resuscitation is necessary. Child goes to nursery on pediatrician's service.to nursery on pediatrician's service.

a.a. 9946499464

b.b. 9946599465

c.c. 9947899478

New ICD-9 CodesNew ICD-9 Codes

779.31779.31 Feeding problem s newbornFeeding problem s newborn

779.32779.32 Bilious vomiting newbornBilious vomiting newborn

779.33779.33 Other vomiting in newbornOther vomiting in newborn

779.34779.34 Failure to thrive newbornFailure to thrive newborn

779.82779.82 Apparent life threatening eventApparent life threatening event

V20.31V20.31Health supervision for newborn Health supervision for newborn younger than 8 daysyounger than 8 days

Transitional CareTransitional Care Use CONSULTS- whoops!!Use CONSULTS- whoops!! Or new hospital admit codeOr new hospital admit code

Car Seat TestingCar Seat Testing Head CoolingHead Cooling Total Body CoolingTotal Body Cooling Prenatal VisitsPrenatal Visits Critical care transportsCritical care transports

Bundled proceduresBundled procedures

FRAUDFRAUD: intentional deception or : intentional deception or misrepresentation made by individuals misrepresentation made by individuals knowing it to be false. To prove fraud, it knowing it to be false. To prove fraud, it must be established that the acts were must be established that the acts were made willfully, knowingly and intentionally made willfully, knowingly and intentionally with a reckless disregard for the ruleswith a reckless disregard for the rules

ABUSEABUSE: : a practice a practice that directly or indirectly that directly or indirectly results in unnecessary costs to Medicare or results in unnecessary costs to Medicare or other programs other programs with with no willful intent provenno willful intent proven

372.06372.06 Acute chemical conjunctivitisAcute chemical conjunctivitis

372.06372.06 Vomiting fecal materialVomiting fecal material

756.72756.72 OmphalocoeleOmphalocoele

756.73756.73 GastroschisisGastroschisis

768.70 768.70 HIE, unspecifiedHIE, unspecified

768.71768.71 Mild HIEMild HIE

768.72768.72 Moderate HIEModerate HIE

768.73768.73 Severe HIESevere HIE

CodeCode W RVU ’10W RVU ’10 T RVU ‘10T RVU ‘10 W RVU ‘09W RVU ‘09 T RVU ‘09T RVU ‘09

9946699466 4.794.79 6.556.55 4.794.79 6.436.43

9946799467 2.402.40 3.293.29 2.402.40 3.213.21

9946899468 18.4618.46 24.6124.61 18.4618.46 24.1424.14

9946999469 7.997.99 10.7510.75 7.997.99 10.5210.52

9947199471 15.9815.98 21.5421.54 15.9815.98 21.5721.57

9947299472 7.997.99 10.7810.78 7.997.99 10.6510.65

HospitalHospital ConsultsConsults

CodeCode W RVU ’10W RVU ’10 T RVU ‘10T RVU ‘10 W RVU ‘09W RVU ‘09 T RVU ‘09T RVU ‘09

9922199221 1.891.89 2.612.61 9925199251 1.001.00 1.351.35

9922299222 2.572.57 3.533.53 9925299252 1.501.50 2.102.10

9922399223 3.793.79 5.185.18 9925399253 2.272.27 3.183.18

9925499254 3.293.29 4.594.59

9925599255 4.004.00 5.605.60

Office visitsOffice visits ConsultationConsultation InpatientInpatient

CodeCode W RVU ’10W RVU ’10 TRVU ‘10TRVU ‘10 CodeCode W RVU ‘09W RVU ‘09 T RVU ‘09T RVU ‘09

9920199201 0.480.48 1.081.08 9925199251 1.001.00 1.351.35

9920299202 0.930.93 1.871.87 9925299252 1.501.50 2.102.10

9920399203 1.421.42 2.712.71 9925399253 2.272.27 3.183.18

9920499204 2.432.43 4.204.20 9925499254 3.293.29 4.594.59

9920599205 3.173.17 5.285.28 9925599255 4.004.00 5.605.60

9921199211 0.180.18 0.530.53

9921299212 0.480.48 1.081.08

9921399213 0.970.97 1.821.82

9921499214 1.501.50 2.732.73

9921599215 2.112.11 3.773.77

Difficulty distinguishing between formal Difficulty distinguishing between formal requests for repeat consultation and requests for repeat consultation and specialist scheduled revisitsspecialist scheduled revisits

Difficulty distinguishing between Difficulty distinguishing between consultations and transfers of careconsultations and transfers of care

The codes will remain in CPTThe codes will remain in CPT This policy affects ONLY MedicareThis policy affects ONLY Medicare Check with your Medicaid providerCheck with your Medicaid provider


9946499464

Attendance at delivery (when requested by Attendance at delivery (when requested by the delivering physician) and initial the delivering physician) and initial stabilization of newborn.stabilization of newborn.

99465 - "Delivery/birthing room resuscitation: provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output" cannot be applied unless these services are provided, even if prepared to do so.


2.2. A neonatologist is asked to care for a newborn A neonatologist is asked to care for a newborn infant in the normal nursery.infant in the normal nursery.

a.a. 9946199461

b.b. 9946299462

c.c. 9946099460


99460 99460

Initial hospital or birthing center care, per Initial hospital or birthing center care, per day, for the evaluation and management of day, for the evaluation and management of the normal newborn infant. the normal newborn infant.

Note: For child born & discharged on the same day, use 99463.


3.3. A neonatologist admits a newborn to the NICU A neonatologist admits a newborn to the NICU with mild respiratory distress requiring 30% with mild respiratory distress requiring 30% oxygen.oxygen.

a.a. 9947899478

b.b. 9947799477

c.c. 9946899468


99477 99477 Initial hospital care, per day, for the Initial hospital care, per day, for the evaluation and management of the neonate, evaluation and management of the neonate, 28 days of age or less, who requires 28 days of age or less, who requires intensive observation, frequent intensive observation, frequent interventions, and other intensive care interventions, and other intensive care services.services.

99478 - is a subsequent, not initial day, code.

99468 - is a critical neonatal care service code.


4.4. A neonatologist is caring for a baby in the A neonatologist is caring for a baby in the newborn nursery on the second day of life. The newborn nursery on the second day of life. The baby develops jaundice and needs baby develops jaundice and needs bilirubin lights. The infant is feeding well.bilirubin lights. The infant is feeding well.

a.a. 8846188461

b.b. 9946099460

c.c. 9946399463


None is correct.None is correct.

99462 - (Subsequent hospital care, per day, for the 99462 - (Subsequent hospital care, per day, for the evaluation and management of a normal evaluation and management of a normal newborn) would be correct in this case.newborn) would be correct in this case.


5.5. A neonatologist is called to the delivery room A neonatologist is called to the delivery room for a meconium stained infant. for a meconium stained infant. Neonatal Neonatal resuscitation is performed. Child responds resuscitation is performed. Child responds well, goes onto pediatric service.well, goes onto pediatric service.

a.a. 9946499464

b.b. 9946599465

c.c. 9947799477


99465 99465 Delivery/birthing room resuscitation: Delivery/birthing room resuscitation: provision of positive pressure ventilation provision of positive pressure ventilation and/or chest compressions in the presence and/or chest compressions in the presence of acute inadequate ventilation and/or of acute inadequate ventilation and/or cardiac output.cardiac output.

99464 - applies when attending delivery, but active 99464 - applies when attending delivery, but active resuscitation is not required.resuscitation is not required.

99477 - is a first day intensive care admission code, not a 99477 - is a first day intensive care admission code, not a DR code.DR code.


6.6. A neonatologist is called to another hospital A neonatologist is called to another hospital transfer a baby to his NICU. Thirty minutes are transfer a baby to his NICU. Thirty minutes are spent in the ambulance to the hospital and 70 spent in the ambulance to the hospital and 70 minutes are spent face-to-face with minutes are spent face-to-face with the the baby including transport back to his baby including transport back to his NICU.NICU.

a.a. 9946699466

b.b. 9946799467

c.c. 9946599465


99466 99466 Critical care services delivered by a Critical care services delivered by a physician, face-to-face, during an interfacility physician, face-to-face, during an interfacility transport of critically ill or critically injured transport of critically ill or critically injured pediatric patient, 24 months of age or less; pediatric patient, 24 months of age or less; first 30-74 minutes of hands on care during first 30-74 minutes of hands on care during transporttransport

99467 - is added separately (to 99466) for time spent 99467 - is added separately (to 99466) for time spent beyond 74 minutes.beyond 74 minutes.

99465 - is a DR code for resuscitation99465 - is a DR code for resuscitation..


7.7. A neonatologist admits a 30-week gestation, A neonatologist admits a 30-week gestation, 1400 g, infant to1400 g, infant to the NICU. The baby is the NICU. The baby is intubated.intubated.

a.a. 9946899468

b.b. 9947799477

c.c. 9946099460


99468 99468

Initial inpatient neonatal critical care, per Initial inpatient neonatal critical care, per day, for the evaluation and management of a day, for the evaluation and management of a critically ill neonate, 28 days of age or lesscritically ill neonate, 28 days of age or less

99477 - is for intensive, but not critical care services.99477 - is for intensive, but not critical care services.

99460 - is normal baby, first day care.99460 - is normal baby, first day care.


8.8. A five-day-old infant now 30 5/7-weeks PMA & A five-day-old infant now 30 5/7-weeks PMA & 1360 g, remains intubated in the NICU.1360 g, remains intubated in the NICU.

a.a. 9946899468

b.b. 9946999469

c.c. 9947899478


99469 99469

Subsequent inpatient neonatal critical care, Subsequent inpatient neonatal critical care, per day, for the evaluation and management per day, for the evaluation and management of a critically ill neonate, 28 days of age or of a critically ill neonate, 28 days of age or lessless

99468 - is critical care, first day.99468 - is critical care, first day.

99478 - is for the < 1500 gram, recovering infant's care.99478 - is for the < 1500 gram, recovering infant's care.


9.9. An 11-day-old 1800-gram infant is in the NICU An 11-day-old 1800-gram infant is in the NICU and requires a TPN and ¼-liter flow and requires a TPN and ¼-liter flow oxygen at 30%.oxygen at 30%.

a.a. 9947999479

b.b. 9947899478

c.c. 9948099480


99479 99479 Subsequent intensive care, per day, for the Subsequent intensive care, per day, for the evaluation and management of the evaluation and management of the recovering low birth weight infant (present recovering low birth weight infant (present body weight of 1500-2500 grams)body weight of 1500-2500 grams)

99478 - applies only below 1500 grams body weight.99478 - applies only below 1500 grams body weight.

99480 - is used when body weight exceeds 2500 grams 99480 - is used when body weight exceeds 2500 grams (to 5000 g)(to 5000 g)


10.10. A now 2150 g, 35-day-old infant remains in A now 2150 g, 35-day-old infant remains in the NICU on NCPAP.the NICU on NCPAP.

a.a. 9946999469

b.b. 9947999479

c.c. 9947299472


99472 99472 Subsequent inpatient pediatric critical care, Subsequent inpatient pediatric critical care, per day, for the evaluation and management per day, for the evaluation and management of a critically ill infant or young child, 29 days of a critically ill infant or young child, 29 days through 24 months of agethrough 24 months of age

99479 - is for subsequent intensive care of recovering infants with current weight 1500 - 2500 g.

99469 - applies to subsequent (beyond 1st day) critical care up to 28 d after birth.


11.11. A 45-day-old infant weighing 4200 A 45-day-old infant weighing 4200 grams is grams is recovering from meconium aspiration and has recovering from meconium aspiration and has continuous vital sign monitoring.continuous vital sign monitoring.

a.a. 9946299462

b.b. 9948099480

c.c. 9947299472


99480 99480

Subsequent intensive care, per day, for the Subsequent intensive care, per day, for the evaluation and management of the evaluation and management of the recovering infant (present body weight of recovering infant (present body weight of 2501-5000 grams)2501-5000 grams)

99462 - (normal newborn subsequent care) and 99472 99462 - (normal newborn subsequent care) and 99472 (ongoing critical care @ >28 d) do not apply here.(ongoing critical care @ >28 d) do not apply here.


12.12. A neonatologist is asked to attend a A neonatologist is asked to attend a delivery of a newborn with a non-reassuring delivery of a newborn with a non-reassuring fetal heart tracing. The infant is vigorous and fetal heart tracing. The infant is vigorous and requires no resuscitation. The infant is requires no resuscitation. The infant is admitted to the normal nursery.admitted to the normal nursery.

a.a. 99464; 9946099464; 99460b.b. 99434; 9947799434; 99477c.c. 99465; 9946899465; 99468


99464 99464 Attendance at delivery (when requested by the Attendance at delivery (when requested by the delivering physician) and initial stabilization of delivering physician) and initial stabilization of newborn, newborn,

in combination within combination with99460 99460

Initial hospital or birthing center care, per day, Initial hospital or birthing center care, per day, for theevaluation and management of the normal for theevaluation and management of the normal newborn infantnewborn infant

The other codes:The other codes:99465 - requires active resuscitation99465 - requires active resuscitation99468 - requires critical patient status to be applied.99468 - requires critical patient status to be applied.


13.13. A three-day-old baby is discharged from the A three-day-old baby is discharged from the normal nursery. The neonatologist spends 20 normal nursery. The neonatologist spends 20 minutes in the discharge process and 20 minutes in the discharge process and 20 minutes chatting with the nurses in the normal minutes chatting with the nurses in the normal nursery.nursery.

a.a. 9923899238

b.b. 9923999239

c.c. 9946299462


9923899238

Hospital discharge day management; 30 Hospital discharge day management; 30 minutes or lessminutes or less

99239 - only applies if the time for the discharge 99239 - only applies if the time for the discharge process process is > 30 minutes! is > 30 minutes!

99462 - is a normal NB, subsequent-but not 99462 - is a normal NB, subsequent-but not discharge-day charge codedischarge-day charge code


14.14. A 46-day-old infant 2400-gram infant is A 46-day-old infant 2400-gram infant is discharged from the NICU todischarged from the NICU to home. The home. The neonatologist spends 40 minutes with the neonatologist spends 40 minutes with the parents and in dictating the discharge parents and in dictating the discharge summary.summary.

a.a. 9947999479

b.b. 9923999239

c.c. 99479; 9923999479; 99239


99239 99239

Hospital discharge day more than 30 minutesHospital discharge day more than 30 minutes

99479 - is a subsequent day charge, but cannot be 99479 - is a subsequent day charge, but cannot be superimposed on discharge day charge.superimposed on discharge day charge.


15.15. A neonatologist admits a baby to the normal A neonatologist admits a baby to the normal newborn nursery at 7:00am in the morning and newborn nursery at 7:00am in the morning and the baby is discharged at 11:00pm on the the baby is discharged at 11:00pm on the same day. The neonatologist spends 15 same day. The neonatologist spends 15 minutes in the discharge process.minutes in the discharge process.

a.a. 9946099460

b.b. 9923899238

c.c. 9946399463


99463 99463

Initial hospital or birthing center care, per Initial hospital or birthing center care, per day, for the evaluation and management of day, for the evaluation and management of the normal newborn infant admitted and the normal newborn infant admitted and discharged on the same datedischarged on the same date

Cannot use first day admission code (99460) & discharge Cannot use first day admission code (99460) & discharge day code (99238 or 9) on the same day.day code (99238 or 9) on the same day.

CODING 1 0 1 Charles T. Hankins, MD. Coding for Neonatal-Perinatal Medicine 1.A neonatologist is...

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