CODING
101
Charles T. Hankins, MD
Coding for Neonatal-Perinatal Medicine
1. A neonatologist is asked to attend a repeat csection. The infant is born with Apgar scores of
8, 9. No resuscitation is necessary. Child goes
to nursery on pediatrician's service.
a. 99464
b. 99465
c. 99478
New ICD-9 Codes
779.31
779.32
779.33
779.34
779.82
V20.31
Feeding problem s newborn
Bilious vomiting newborn
Other vomiting in newborn
Failure to thrive newborn
Apparent life threatening event
Health supervision for newborn
younger than 8 days
 Transitional Care
 Use CONSULTS- whoops!!
 Or new hospital admit code
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Car Seat Testing
Head Cooling
Total Body Cooling
Prenatal Visits
Critical care transports
 Bundled procedures
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
372.06
372.06
756.72
756.73
768.70
768.71
768.72
768.73
Acute chemical conjunctivitis
Vomiting fecal material
Omphalocoele
Gastroschisis
HIE, unspecified
Mild HIE
Moderate HIE
Severe HIE
372.06
372.06
756.72
756.73
768.70
768.71
768.72
768.73
Acute chemical conjunctivitis
Vomiting fecal material
Omphalocoele
Gastroschisis
HIE, unspecified
Mild HIE
Moderate HIE
Severe HIE
Code
W RVU ’10
T RVU ‘10
W RVU ‘09
T RVU ‘09
99466
4.79
6.55
4.79
6.43
99467
2.40
3.29
2.40
3.21
99468
18.46
24.61
18.46
24.14
99469
7.99
10.75
7.99
10.52
99471
15.98
21.54
15.98
21.57
99472
7.99
10.78
7.99
10.65
Hospital
Code
W RVU ’10
Consults
T RVU ‘10
W RVU ‘09
T RVU ‘09
99221
1.89
2.61
99251
1.00
1.35
99222
2.57
3.53
99252
1.50
2.10
99223
3.79
5.18
99253
2.27
3.18
99254
3.29
4.59
99255
4.00
5.60
Office visits
Code
W RVU ’10
Consultation Inpatient
TRVU ‘10
Code
W RVU ‘09
T RVU ‘09
99201
0.48
1.08
99251
1.00
1.35
99202
0.93
1.87
99252
1.50
2.10
99203
1.42
2.71
99253
2.27
3.18
99204
2.43
4.20
99254
3.29
4.59
99205
3.17
5.28
99255
4.00
5.60
99211
0.18
0.53
99212
0.48
1.08
99213
0.97
1.82
99214
1.50
2.73
99215
2.11
3.77
 Difficulty distinguishing between formal
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
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
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.
Coding for Neonatal-Perinatal Medicine
2. A neonatologist is asked to care for a newborn
infant in the normal nursery.
a. 99461
b. 99462
c. 99460
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.
Coding for Neonatal-Perinatal Medicine
3. A neonatologist admits a newborn to the NICU
with mild respiratory distress requiring 30%
oxygen.
a. 99478
b. 99477
c. 99468
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.
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.
a. 88461
b. 99460
c. 99463
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.
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.
a. 99464
b. 99465
c. 99477
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.
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.
a. 99466
b. 99467
c. 99465
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.
Coding for Neonatal-Perinatal Medicine
7. A neonatologist admits a 30-week gestation,
1400 g, infant to the NICU. The baby is
intubated.
a. 99468
b. 99477
c. 99460
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.
Coding for Neonatal-Perinatal Medicine
8. A five-day-old infant now 30 5/7-weeks PMA &
1360 g, remains intubated in the NICU.
a. 99468
b. 99469
c. 99478
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.
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%.
a. 99479
b. 99478
c. 99480
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)
Coding for Neonatal-Perinatal Medicine
10. A now 2150 g, 35-day-old infant remains in
the NICU on NCPAP.
a. 99469
b. 99479
c. 99472
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.
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.
a. 99462
b. 99480
c. 99472
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.
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.
a. 99464; 99460
b. 99434; 99477
c. 99465; 99468
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.
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.
a. 99238
b. 99239
c. 99462
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
day charge code
discharge-
Coding for Neonatal-Perinatal Medicine
14. A 46-day-old infant 2400-gram infant is
discharged from the NICU to home. The
neonatologist spends 40 minutes with the
parents and in dictating the discharge
summary.
a. 99479
b. 99239
c. 99479; 99239
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.
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.
a. 99460
b. 99238
c. 99463
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.