CODING 1 0 1

1. CODING 1 0 1 Charles T. Hankins, MD

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. Hospital visit codesCritical Care RVU Changes 2009 to 2010

9. Hospital visit codesHospital Visit Compared to Inpatient Consultations

10. No consultations!!

11. 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

12. 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.

13. Coding for Neonatal-Perinatal Medicine 2. A neonatologist is asked to care for a newborn infant in the normal nursery. • 99461 • 99462 • 99460

14. 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.

15. Coding for Neonatal-Perinatal Medicine 3. A neonatologist admits a newborn to the NICU with mild respiratory distress requiring 30% oxygen. • 99478 • 99477 • 99468

16. 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.

17. 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

18. 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.

19. 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

20. 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.

21. 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

22. 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.

23. 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

24. 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.

25. 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

26. 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.

27. 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

28. 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)

29. Coding for Neonatal-Perinatal Medicine 10. A now 2150 g, 35-day-old infant remains in the NICU on NCPAP. • 99469 • 99479 • 99472

30. 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.

31. 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

32. 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.

33. 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

34. 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.

35. 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

36. 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

37. 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

38. 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.

39. 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

40. 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.