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Family Practice Coding Alert

Follow-up Care for Newborns Means Additional Codes Reported and Reimbursement Received

According to the American Academy of Family Physicians (AAFP), more than 60 percent of their members report they provide newborn care immediately following delivery and that they follow up with these young patients in the ensuing days and weeks. Several codes are used to report the care provided, according to Beth Kluge, CPC, supervisor of medical coding and education for Mercy Health Systems in Janesville, Wis.
Note: In some cases, the FP will personally deliver the child. These services are usually covered by the global package assigned for maternity care if the physician cared for the patient throughout her pregnancy (e.g., 59400, routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care). For more information, see Ob-Gyn Coding Alert Volume 2, No. 7, July 1999.
Abnormal Birth: Coding Attendance at Delivery     
Sometimes an obstetrician has provided the maternity care but the FP is asked to attend  an abnormal birth (e.g., premature delivery, multiple births, etc.). "This often occurs when the mother has decided that the FP will become the child's primary physician," Kluge explains. "The OB then might ask the FP to attend. As with other consultations, the delivering physician must directly request that the other physician be in attendance in order to bill the consult codes."
When this is documented, the FP's services are reported with 99436 (attendance at delivery [when requested by delivering physician] and initial stabilization of newborn). Among the services the FP provides at delivery are initial assessments like Apgar testing and suctioning the airway if the child respirated meconium. These services are included in 99436. 
If the child has significant cardiac or pulmonary problems immediately after birth, the delivering physician will often call on a neonatologist or pediatrician. The FP may be required to resuscitate a newborn in distress. This is reported with 99440 (newborn resuscitation: provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output). This CPT code would be used instead of 99436; you cannot bill both.
On occasion, family physicians may be asked to assist during a cesarean delivery. This would be assigned the appropriate code (e.g., 59514, cesarean delivery only), appended with modifier -80 (assistant surgeon).

Care for Healthy Newborn    
CPT provides specific codes for the care of a healthy newborn, Kluge says. "When reporting the initial assessment, family practice coders would assign 99431 (history and examination of the normal newborn infant, initiation of diagnostic and treatment programs and preparation of hospital records. [This code should also be used for birthing-room deliveries]). Unlike the initial hospital care codes that would be assigned for adults (99221-99223), there is only a single code for normal [...]