How do Current Procedural Terminology (CPT®) evaluation and management (E/M) guidelines apply to normal newborn care?

There are no key components for normal newborn care (99460–99463) and discharge codes (99238, 99239). According to CPT, normal newborn care E/M codes include maternal or fetal and newborn history, newborn physical examination(s), ordering of diagnostic tests and treatments, meetings with the family, and documentation in the medical record. Further guidance is provided in the intraservice work described for each code in the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) database. (You can obtain a copy of RBRVS Data Manager at https://catalog.ama-assn.org/Catalog.) For example, code 99462 includes a comprehensive interval history, comprehensive examination, measurements, sensory screening, ordering medically necessary laboratory tests, and relevant counseling with parents.

Normal newborn care codes are reported

How should we report initial newborn care when the physician does not...

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