Newborn Nursery Billing Codes – Neonatal Billing Codeline

Neonatology is a pediatric discipline that focuses on the medical care of newborn infants, particularly those who are sick or premature. It is a hospital-based specialist practice that is typically performed in neonatal critical care units (NICUs). Neonatologists’ primary patients are newborn children who are unwell or require particular medical care due to the following:

  • Prematurity
  • Birth weight is low
  • Restriction of intrauterine growth
  • Malformations or impairments that are present at birth
  • Sepsis
  • Hypoplasia of the lungs
  • Asphyxia during childbirth

Coding:

Physicians should add codes for Newborn Care Services Codes for evaluation and management (E/M) services provided to healthy babies during the first days of life prior to a hospital release. The following codes apply to the first care of a typical newborn:

Newborn Nursery Billing Codes

99460

Initial hospital or birthing center care, per day, for E/M of a normal newborn infant

99461

Initial care per day, for E/M of normal newborn infant seen in other than hospital or birthing center

99463

Initial hospital or birthing center care, per day, for E/M of a normal newborn infant, admitted and discharged on the same date

The codes 99478-99480 denote intense care offered to evaluate and manage a newborn with a low or extremely low birth weight who is recovering. The code is determined by the infant’s current body weight as follows:

99478

Present bodyweight less than 1500 grams

99479

Present bodyweight of 1500-2500 grams

99480

Present bodyweight of 2501-5000 grams

INPATIENT NEONATAL CRITICAL CARE

The first day of critical care for the evaluation and management of a severely unwell baby aged 28 days or less is coded 99468. This code is reported for a single physician. If another physician delivers critical care to the neonate on the same date, the services are reported using critical care service numbers 99291-99292.

Subsequent days of critical care provided to the critically unwell infant are coded 99469. As with critical care initialization, code 99469 is used to report on a single physician on a certain day.

Attendance at delivery, including newborn resuscitation, is defined by the following procedure codes:

99464 – Attendance upon delivery (where requested by the delivering physician or another trained health care provider) and initial stabilization of the baby

99465 – Resuscitation in the delivery/birthing room, including positive pressure ventilation and/or chest compressions, in the event of acutely insufficient breathing and/or cardiac output

Both codes are identical, and all requirements for reporting attendance at delivery (99464), as well as the neonatal resuscitation code, are the same (99465). As a result, code 99464 cannot be reported in conjunction with code 99465.

The primary distinction between the two codes is in their approach to stabilization or resuscitation. Attendance during delivery (99464) is defined as the use of blow-by oxygen or continuous positive airway pressure (CPAP) in the absence of positive-pressure ventilation. None of these actions, either individually or in combination, will satisfy the requirement to record neonatal resuscitation.

To record the newborn resuscitation code (99465), qualifying resuscitative actions, such as bag-and-mask or bag-to-endotracheal tube ventilation (positive-pressure breathing) with or without CPAP and/or cardiac compressions, are necessary.

Other life support procedures that are necessary for resuscitation may be documented separately, including the following:

  • 31500 Intubation, endotracheal, emergency procedure
  • 31515 Laryngoscopy, direct, for aspiration
  • 36510 Catheterization of umbilical vein for diagnosis or therapy, newborn
  • 94610 Surfactant administration

Caring for sick newborns:

The treatment of neonates who are abnormal but may not require intense services may be reported using initial hospital care codes (99221-99223). Certain infants may require intensive care but do not satisfy the CPT definition of severely sick or injured, which is required for critical care service reporting. (For a definition of critically sick or injured, refer to the Critical Care Services portion of CPT immediately preceding codes 99291-99292.)

Code 99477 is used to describe the initial hospital treatment provided to a neonate (28 days or younger) who is not dangerously ill but requires intensive surveillance, frequent interventions, and other intensive care services. These services include rigorous cardiac and respiratory monitoring, continuous and/or frequent vital sign monitoring, heat maintenance, enteral and/or parenteral dietary modifications, laboratory and oxygen monitoring, and continual observation by a health care team overseen by a physician. This code may only be reported once daily and by a single physician.

Nixxe MBS accurately records both E/M services provided to a healthy infant and NICU services provided to neonates with congenital impairments. To avoid clearinghouse rejections and re-submissions, our team files clean claims the first time and adheres to all-payer policies, rules, and laws. Our billing team leverages their broad knowledge and helps the right application of modifiers in order to avoid denials.