Can 99460 Be Billed Under Mom and Again Under Infant

Set for the unexpected when the patient is expecting.

Oh, those cute little babies! All those fingers and toes and noses — when I grow up, I want to be ane of those volunteers in nurseries who simply sits and rocks babies all twenty-four hour period. It sure beats this crazy coding globe I've gotten myself into. Wouldn't you rather sing rock-a-bye baby, lookout man them while they sleep, stride the flooring when they cry, modify their diaper, feed them, walk the floor once more … I may be rethinking this whole thought.
Babies can exist a handful for sure. Even the healthiest baby requires lots of easily-on attention during the delivery process. From the moment of nativity, the baby is evaluated and, afterward a moment with the mother, is normally handed to a nurse or other skilled attendant to assess the infant's condition. They may utilise the common Apgar system (Appearance, Pulse, Grimace, Activity, Respiration) — in utilize since the early on 1950s. Loftier Apgar scores indicate a salubrious newborn.
Sometimes the obstetric provider has an indication of a possible issue prior to the commitment. Perhaps at that place is meconium (the starting time feces of a fetus or babe) in the amniotic fluid or the fetus' heart rate in utero is low. The obstetrician (OB) needs to take care of the mother, so they volition call in a pediatric provider to intendance for the baby.
In that location are a few different codes the pediatric provider can apply, and they basically depend on the place of service and the condition of the newborn. There are critical care codes that tin can exist used for the newborn, if applicable, merely what we want to talk about at present are the two codes used for attendance at commitment (AAD) and resuscitation.

Attendance at Delivery

CPT® lawmaking 99464 Omnipresence at delivery (when requested by the delivering doctor or other qualified health care professional) and initial stabilization of newborn ways the provider is at the delivery, physically present in the delivery room with hands out, waiting for the baby.
AAPC Coder [at present Codify] states that if the provider misses the commitment by even a few seconds they cannot code 99464. In that case, they demand to choose either initial neonatal care or one of the disquisitional intendance codes, whichever is applicative. Providers must document that they were in the room at the exact time the baby was built-in to use 99464.
The other key point of this code is that the pediatric provider must exist requested by a physician or other qualified healthcare professional. We can reasonably presume the OB is not going to stop delivering the baby to pick up the telephone and page the on-telephone call pediatric provider; the OB volition tell the other staff in the room to do information technology. The documentation needs to back up that the OB requested the folio.
Of grade, nosotros must have medical necessity for AAD. If the hospital mandates that a pediatrician is in the delivery room for all or certain types of deliveries, such as C-sections, this is not deemed medically necessary. The key is that newborn distress is expected, so another person needs to be in the room to take the baby immediately after birth.
AAD includes stabilization of the newborn. Stabilization includes:

• Initial drying
• Stimulation
• Suctioning
• Visual inspection
• Apgar
• Blow-by
• CPAP
• Discussion with OB and/or parents

Delivery/Birthing Room Resuscitation

In contrast, code 99465 Commitment/birthing room resuscitation, provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output is for resuscitation. The description demands that positive pressure ventilation (PPV) or cardiopulmonary resuscitation (CPR) be performed to use this code.
Resuscitation includes:

• CPR
• Bag and mask
• Intubation
• Ventilation (not simply CPAP)

The newborn must be in some sort of distress such as acute inadequate ventilation or cardiac output. Documentation should state acute respiratory distress or failure, or other cardiopulmonary distress. The provider must perform some type of emergency measure to restore breathing and center function.
Both AAD and resuscitation can be billed with initial newborn care (99460), initial neonatal disquisitional intendance (99468), and initial intensive neonate intendance (99477). Code 99465 can exist billed with standby (99360), intubation and central line codes, and other
necessary procedures, as long as they are not performed as a convenience before access to the NICU.
AAD and resuscitation on the same mean solar day cannot be billed together. If the provider is in attendance and then performs resuscitation, merely bill the 99465, since it has the higher relative value units (RVUs).

AAD vs. Resuscitation

Proper coding requires proper documentation. When deciding which code to beak, look for the documentation to state whether the newborn is in distress. If not, attendance at commitment is likely your best option, equally long as the provider is in the room at commitment. If the baby is in distress, wait for documentation of PPV or CPR, and bill the resuscitation code.

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Lori A. Cox, MBA, CPC, CPMA, CPC-I, CEMC, is coding team leader at MedKoder in Hannibal, Mo. She has more 15 years of feel in multiple areas of healthcare including auditing and compliance. Cox has been certified since 2002 and is treasurer of the Quincy, Ill./Hannibal, Mo., local chapter. She is the Region 5 AAPC National Advisory Board representative.

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Source: https://www.aapc.com/blog/50084-coding-newborn-attendance-at-delivery-and-resuscitation/

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