Newborn care service
Normal Newborn Care
It is important to understand when Normal newborn care (Birth through first 28 days) CPT (99460, 99461, 99462, and 99463) are assigned.
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.
99462: Subsequent hospital care, per day, for evaluation and management of normal newborn.
99463: Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant admitted and discharged on the same date.
If newborn needs delivery room attendance or delivery room resuscitation services are coded with 99464 or 99465 respectively.
Defining "Normal" Newborn Care:
A "normal" newborn refers to an infant without any abnormal medical conditions or the need for special care. For coding purposes, normal newborn care is reported using CPT code 99460, which covers the initial evaluation and management of a normal newborn infant within the first 24 hours of birth. This code includes a comprehensive assessment, interventions, and counseling provided to the parents.
Documentation and Diagnosis Coding:
When coding for normal newborn care, it's essential to include the appropriate diagnosis code. For CPT code 99460, the recommended diagnosis is Z37.0 (Single liveborn). This indicates that the newborn is normal and does not have any other diagnoses associated with the encounter.
Additional Procedures and Services:
Procedures such as circumcision are not included in the normal newborn care codes (99460-99463) and should be reported separately. For circumcision procedures, codes 54150 or 54160 should be used, depending on the method of circumcision performed.
54150: Circumcision, using clamp or other device with regional dorsal penile or ring block.
54160: Circumcision, surgical excision other than clamp, device, or dorsal slit; neonate (28 days of age or less).
Do not append Modifier 63.
Coding for Sick Newborns:
When providing services to newborns who are not considered "normal" and require inpatient care, CPT directs you to report hospital inpatient codes (99221-99223), neonatal intensive care codes (99477-99480), or critical care codes (99468-99469) based on the level of care provided and the newborn's condition.
Coding for Intensive Care:
Newborns who require intensive care but do not meet the criteria for critical care should be reported using code 99477 for the initial day of care. Subsequent days of care should be reported using codes 99478-99480, based on the infant's weight and the level of care provided.
Coding for Critical Care:
Newborns who are critically ill or injured should be reported using code 99468 for the initial day of critical care. Subsequent days of critical care should be reported using code 99469. It's important to note that only one physician can report code 99468 or 99469 per day.