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Coding Newborn Care Services
Care of the Normal Newborn Infant
|99460||Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant|
|99461||Initial care, per day, for evaluation and management of normal newborn infant seen in other than hospital or birthing center|
|99463||Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant admitted and discharged on the same date|
Newborn Care in the Office
When the visit is in follow-up to an identified problem such as jaundice, infrequent stools, or infrequent feedings, and the physician, nurse practitioner, or physician assistant provides the service, an office visit (eg, 99212-99215) and problem specific diagnosis codes should be reported.
If no feeding or other health problem has been previously noted, this visit may be the first well child visit when provided by a physician, nurse practitioner or physician assistant. Code 99391 may be reported with diagnosis code V20.2 for this service. This service includes time spent addressing routine feeding issues. However, if significant time beyond that typical of the infant preventive service is spent in counseling, physicians may also report a problem-oriented service (99212-99215) with modifier -25 to indicate the significant and separately identifiable services provided on the same date. Documentation should include approximate time spent face-to-face with the family and patient, notation of time spent in counseling and context of counseling. (Codes may be selected based on time spent in counseling and coordination of care when documentation indicates more than 50% of face-to-face time was spent in these activities.)
If a nurse visit is provided (e.g., weight screen only), code 99211 may be reported. If the nurse visit results in a visit with the physician, only the physician services would be reported.
As a family physician, you may also address needs of the mother during a newborn's encounter (e.g., lactation problems). If separately documented in the mother's chart, you may report these services in addition to the services provided to the infant.
|54150||Circumcision, using clamp or other device with regional dorsal penile or ring block|
|54150-52||Circumcision, as above, without dorsal penile or ring block|
|54160||Circumcision, surgical excision other than clamp, device, or dorsal split, neonate|
|54161||Circumcision as in 54160, child older than 28 days of age|
Caring for Sick Newborns
Code 99477 represents initial hospital care of the infant who is not critically ill but requires intensive observation, frequent interventions, and other intensive care services. These services include intensive cardiac and respiratory monitoring, continuous and/or frequent vital sign monitoring, heart maintenance, enteral and/or parenteral nutritional adjustments, laboratory and oxygen monitoring, and constant observation by the health care team under direct physician supervision. This code may be reported only once per day and by only one physician.
Procedures included in the services represented by code 99477 include those listed for the Critical Care Services subsection of CPT (codes 99291 and 99292) as well as additional procedures listed in the Inpatient Neonatal and Pediatric Critical Care subsection (codes 99468-99476, 99466-99467). These include vascular access procedures, airway and ventilation management services, oral or nasogastric tube placement, bladder aspiration or catheterization, and lumbar puncture among others.
Codes 99478-99480 each are described as "Subsequent intensive care, per day, for the evaluation and management of the recovering very low birth weight infant" with the code selected based upon the present body weight of the infant as below.
|99478||present body weight less than 1500 grams|
|99479||present body weight of 1500-2500 grams|
|99480||present body weight of 2501-5000 grams|
Newborn Critical Care
Critical Care During Transport
Inpatient Neonatal Critical Care
Subsequent days of critical care to the critically ill neonate are reported per day with code 99469. As with the initial critical care, only one physician may report code 99469 on a given date.
CMS Non-Covered Services
Beneficiary Notice 2011- English (*PDF file)
Beneficiary Notice 2011- Spanish (*PDF file)
Coding Newborn Care Services