• Coding for Newborn Care Services

    Newborn Care Services Coding

    Care of the Normal Newborn Infant

    Evaluation and management (E/M) services provided to normal newborns in the first days of life prior to hospital discharge are reported with Newborn Care Services codes. Codes for initial care of the normal newborn include:

    99460 Initial hospital or birthing center care, per day, for E/M of normal newborn infant
    99461 Initial care per day, for E/M of normal newborn infant seen in other than hospital or birthing center
    99463 Initial hospital or birthing center care, per day, for E/M of normal newborn infant admitted and discharged on the same date

    Newborn Care in the Office

    After the newborn has been discharged to home, it is common practice to see the infant to assess for jaundice or any feeding problems. Coding for this service depends on the provider of the service and whether the visit is in follow-up to an already identified problem or screening for problems.

    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 (e.g., 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 Z00.129 (encounter for routine child health examination without abnormal findings) 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.) Diagnosis code Z00.121 (encounter for routine child health examination with abnormal findings) and the appropriate problem diagnosis would be used.

    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.


    Family physicians who perform newborn circumcision should separately report this service. Codes for circumcision procedures include:

    54150 Circumsion, using clamp or other device with regional dorsal penile or ring block
    54150-52 Circumsion, as above, without dorsal penile or ring block
    54160 Circumsion, surgical excision, other than clamp, device, or dorsal slit, neonate (28 days of age or less)
    54161 Circumsion, surgical excision, other than clamp, device, or dorsal slit, neonate, old then 28 days of age  

    Caring for Sick Newborns

    When providing E/M services to other than normal newborns, choose the level of care based on the intensity of the service and status of the newborn. Care of newborns who are not normal but do not require intensive services may be reported with codes for initial hospital care (99221-99223). Some infants may require intensive care services but do not meet the CPT definition of critically ill or injured required for reporting of critical care services. (For the definition of critically ill or injured see the Critical Care Services subsection of CPT before codes 99291-99292.)

    Code 99477 represents initial hospital care of the neonate (28 days or younger) 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, heat 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.

    Subsequent hospital care of infants who are not critically ill or injured as defined in CPT but who had a very low birth weight and continue to require intensive care services as described for code 99477 above may be reported with codes 99478-99480.

    Codes 99478-99480 each are described as, "Subsequent intensive care, per day, for the evaluation and management of the recovering low or 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

    When the newborn is critically ill or injured, codes exist for reporting of services provided during interfacility transport, initial critical care, and subsequent critical services. Reporting of codes for the services requires careful attention to CPT instructions and when more than one physician is caring for the infant, attention to which physician reports which codes.

    Critical Care During Transport

    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, are reported based on the time of face-to-face care beginning when the physician assumes primary responsibility at the referring hospital/facility and ending when the receiving hospital/facility accepts responsibility for the patient's care. Report code 99466 for 30-74 minutes of hands-on care and code 99467 for each additional 30 minutes of hands-on care. Less than 30 minutes of hands-on care during transport would not be separately reported.

    Inpatient Neonatal Critical Care

    The initial day of critical care for the evaluation and management of a critically ill neonate, 28-days of age or less, is reported with code 99468. Only one physician may report this code. If another physician provides critical care services to the neonate on the same date, that physician must report the services with critical care service codes 99291-99292.

    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.

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