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CODING 1 0 1. Charles T. Hankins, MD. Coding for Neonatal-Perinatal Medicine. 1. A neonatologist is asked to attend a repeat c-section. The infant is born with Apgar scores of 8, 9. No resuscitation is necessary. Child goes to nursery on pediatrician's service. 99464 99465 99478.

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Coding 1 0 1 l.jpg

CODING 1 0 1

Charles T. Hankins, MD


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Coding for Neonatal-Perinatal Medicine

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

  • 99464

  • 99465

  • 99478


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New ICD-9 Codes

779.31 Feeding problem s newborn

779.32 Bilious vomiting newborn

779.33 Other vomiting in newborn

779.34 Failure to thrive newborn

779.82 Apparent life threatening event

V20.31 Health supervision for newborn younger than 8 days


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New Code Proposals

  • Transitional Care

    • Use CONSULTS- whoops!!

    • Or new hospital admit code

  • Car Seat Testing

  • Head Cooling

  • Total Body Cooling

  • Prenatal Visits

  • Critical care transports

    • Bundled procedures


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You don’t have to be perfect!

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

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


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New ICD 9 Codes

372.06 Acute chemical conjunctivitis

372.06 Vomiting fecal material

756.72 Omphalocoele

756.73 Gastroschisis

768.70 HIE, unspecified

768.71 Mild HIE

768.72 Moderate HIE

768.73 Severe HIE


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New ICD 9 Codes

372.06 Acute chemical conjunctivitis

372.06 Vomiting fecal material

756.72 Omphalocoele

756.73 Gastroschisis

768.70 HIE, unspecified

768.71 Mild HIE

768.72 Moderate HIE

768.73 Severe HIE


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Hospital visit codesCritical Care RVU Changes 2009 to 2010


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Hospital visit codesHospital Visit Compared to Inpatient Consultations



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CMS Stopped Paying for Consultations

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

Difficulty distinguishing between consultations and transfers of care

The codes will remain in CPT

This policy affects ONLY Medicare

Check with your Medicaid provider


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Coding for Neonatal-Perinatal Medicine

99464

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


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Coding for Neonatal-Perinatal Medicine

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

  • 99461

  • 99462

  • 99460


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Coding for Neonatal-Perinatal Medicine

99460 

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

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


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Coding for Neonatal-Perinatal Medicine

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

  • 99478

  • 99477

  • 99468


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Coding for Neonatal-Perinatal Medicine

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.

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

99468 - is a critical neonatal care service code.


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Coding for Neonatal-Perinatal Medicine

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

  • 88461

  • 99460

  • 99463


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Coding for Neonatal-Perinatal Medicine

None is correct.

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


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Coding for Neonatal-Perinatal Medicine

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

  • 99464

  • 99465

  • 99477


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Coding for Neonatal-Perinatal Medicine

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.

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

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


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Coding for Neonatal-Perinatal Medicine

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

  • 99466

  • 99467

  • 99465


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Coding for Neonatal-Perinatal Medicine

99466

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

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

99465 - is a DR code for resuscitation.


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Coding for Neonatal-Perinatal Medicine

7. A neonatologist admits a 30-week gestation, 1400 g, infant tothe NICU. The baby is intubated.

  • 99468

  • 99477

  • 99460


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Coding for Neonatal-Perinatal Medicine

99468

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

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

99460 - is normal baby, first day care.


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Coding for Neonatal-Perinatal Medicine

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

  • 99468

  • 99469

  • 99478


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Coding for Neonatal-Perinatal Medicine

99469

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

99468 - is critical care, first day.

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


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Coding for Neonatal-Perinatal Medicine

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

  • 99479

  • 99478

  • 99480


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Coding for Neonatal-Perinatal Medicine

99479

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

99478 - applies only below 1500 grams body weight.

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


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Coding for Neonatal-Perinatal Medicine

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

  • 99469

  • 99479

  • 99472


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Coding for Neonatal-Perinatal Medicine

99472

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


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Coding for Neonatal-Perinatal Medicine

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

  • 99462

  • 99480

  • 99472


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Coding for Neonatal-Perinatal Medicine

99480

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

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


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Coding for Neonatal-Perinatal Medicine

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

  • 99464; 99460

  • 99434; 99477

  • 99465; 99468


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Coding for Neonatal-Perinatal Medicine

99464

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

in combination with

99460

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

The other codes:

99465 - requires active resuscitation

99468 - requires critical patient status to be applied.


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Coding for Neonatal-Perinatal Medicine

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

  • 99238

  • 99239

  • 99462


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Coding for Neonatal-Perinatal Medicine

99238

Hospital discharge day management; 30 minutes or less

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

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


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Coding for Neonatal-Perinatal Medicine

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

  • 99479

  • 99239

  • 99479; 99239


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Coding for Neonatal-Perinatal Medicine

99239

Hospital discharge day more than 30 minutes

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


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Coding for Neonatal-Perinatal Medicine

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

  • 99460

  • 99238

  • 99463


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Coding for Neonatal-Perinatal Medicine

99463

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

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


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