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Newborn baby lying in a hospital incubator.

How to code for care during newborn’s hospital admission

February 1, 2025

Newborns may require varying levels of care during their hospital stay. Even a seemingly healthy newborn can become ill unexpectedly.

Accurate physician documentation and appropriate code selection are necessary to ensure that providers receive proper payment for their services.

Following is an overview of coding for various levels of newborn care and examples of how care levels may change during a newborn’s hospital admission.

Normal newborn care

Normal newborn care is reported with Current Procedural Terminology (CPT) codes 99460-99463. These codes apply when newborns are healthy and do not require significant medical interventions. They may be observed for illness related to maternal pregnancy complications and may require some testing or monitoring but are not sick.

Sick newborn care

Sick newborn care is reported with hospital inpatient codes 99221-99223 and 99231-99233. A sick newborn has a manifesting problem that supports the need for diagnostic investigation or therapy and typically requires therapeutic intervention. Code selection is based on whether the service was initial or subsequent.

Intensive care

Intensive care is reported with codes 99477-99480. Code selection is based on the age or weight of the patient and whether the service was initial or subsequent. Initial intensive care does not factor in the patient's weight but rather specifies an age range.

Neonatal critical care

Neonatal critical care is reported with codes 99468 and 99469 for treating infants ages 28 days or younger. A critical newborn has a condition that requires complex medical decision-making, a high probability of imminent or life-threatening deterioration, or organ system failure. Some services are bundled into critical care, such as emergency endotracheal intubation, newborn catheterization of the umbilical vein and venous blood collection by venipuncture.

CPT provides an inclusive list of bundled and separately reportable procedures for critically ill patients. It’s important to note that non-neonatal critical care services have different procedures bundled into codes 99291 and 99292 from those reported with codes 99468 and 99469.

Newborn care, whether normal or sick, can be complex when the patient has varying levels of care. Following are scenarios that could arise during the birth admission and how to code for them.

Vignette 1

A physician provides normal initial newborn care in the hospital setting (99460) on day 1. On day 2, the same physician provides normal subsequent newborn care (99462) and sick care of moderate decision-making (99232). The physician can report a CPT code from both code ranges for day 2. CPT code 99462 requires a 25 modifier.

Vignette 2

A pediatrician provides critical newborn care on day 1 (99468). On day 2, the same physician provides intensive newborn care for the infant who weighs 1,700 grams (99479).

Vignette 3

Two physicians of different specialties and group practices provide care on days 1 and 2 of the birth admission. On day 1, the pediatrician provides initial normal newborn care (99460). On day 2, the same pediatrician provides normal newborn care in the morning (99462). Later that afternoon, a pediatric specialist is called in and provides newborn critical care (99468).

Resources

Correction

The Coding Corner column in the January issue should have stated that codes 98008-98015 are for audio-only visits for new and established patients, and a minimum of 11 minutes of medical discussion is required to report the service, even if that visit is leveled based on medical decision-making. Also, in Table 1, the heading above code 98016 should read Asynchronous services. A fact sheet on telemedicine coding is available at https://bit.ly/3WaT6e5.

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