CPT code 99465 is a common medical procedure code used for newborns in the delivery or birthing room. It is one of the two codes under “Delivery/Birthing Room Attendance and Resuscitation Services.” This code category ranges from CPT 99464 to 99465, maintained by the American Medical Association (AMA).
When it comes to delivering a baby, even the healthiest of all requires all hands on deck. All of this begins right after the baby is born, with the evaluation and assessment of their condition by a specialist. When it comes to medical coding for the newborn’s assessment, various codes are used. These codes depend on the place of service (POS), the baby’s medical condition, etc. Two different codes are used for critical care of newborns attendance at the time of delivery (AAD) and resuscitation. They include CPT Code 99464 & CPT Code 99465. For proper medical billing and coding, being up-to-date and following the newborn coding guidelines 2022 is essential.
99465 CPT code description:
Below is the code description for CPT 99465:
“Delivery/birthing room resuscitation, provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output”
According to AAPC, the provider resuscitates a newborn in cardiopulmonary distress in the delivery room, providing the following:
– Ventilation
– Or breathing
– And Chest compressions
When to bill CPT Code 99465?
The CPT code is for resuscitation. In order to bill the CPT Code 99465, positive pressure ventilation (PPV) or cardiopulmonary resuscitation (CPR) must be performed. According to AAPC, resuscitation is the act that comprises:
– CPR
– Use of a mask and a bag
– Ventilation (not just CPAP)
– Intubation.
For billing CPT code 99465, the newborn must be in some sort of distress, which should be stated in the documentation. This distress could be classified/documented as any of the following:
– Acute inadequate ventilation or cardiac output
– Acute respiratory distress or failure
– Other cardiopulmonary distress
CPT code 99465 only should be billed if the other physician was present at the time of delivery and then later performs resuscitation. This CPT code has higher relative value units (RVUs). For billing CPT code 99465, proper documentation is required to support whether the newborn was in distress or not. According to AAPC, attendance at delivery (AAD) and resuscitation can’t be billed together on the same day of service.
99464 CPT code description:
Below is the code description for CPT 99464:
“Attendance at delivery (when requested by the delivering physician or other qualified health care professional) and initial stabilization of newborn.”
A qualified physician is present in attendance during the delivery of the newborn at the request of the delivering physician for the basic stabilization right after delivery. It means the other physician is present in the delivery room, physically waiting for the delivery of the newborn baby. This is typically when fetal distress or other complications are anticipated.
What code is used for blow-by oxygen in newborns/infants?
CPT code 99464 also includes blow-by oxygen or continuous positive airway pressure (CPAP) without positive-pressure ventilation (PPV) to the newborn.
What is the difference between CPAP & PPV?
One of the major differences between CPAP and PPV is when they should be delivered.
– Positive pressure ventilation (PPV) should be provided if the baby has a heart rate of < 100 bpm and has apnea/is gasping for breath. The air is provided to the newborn via a mask or inflating bag or T-piece resuscitator. This process improves the air exchange between the lungs and the outside.
– Supplemental oxygen and continuous positive airway pressure (CPAP) are considered for newborns with a heart rate > 100 bpm with labored breathing or cyanosis. CPAP should be administered if the below-mentioned conditions are present:
– Respiratory acidosis
– Apnea of prematurity
– Atelectasis
– Respiratory distress syndrome
How to use CPT Code 99464?
According to AAPC codify, even if the other physician is a few moments/seconds late into the delivery room, CPT code 99464 shouldn’t be coded. In a case like this, another more accurate or specific code for critical or neonatal care must be used. In order to use CPT code 99464, the physician must the present in the room at the exact time of delivery of the newborn. One of the essential things to understand is that CPT Code 99464 should only be billed if the pediatric physician was requested by the delivering physician. Moreover, the documentation must include that the OB requested the page for calling the pediatric physician to be in the room.
Medical necessity for an AAD must be present and supported by the documentation as well. In case the particular practice/provider has a mandate to have pediatricians in the room at the time of delivery or C-sections, it is not considered a medical necessity. CPT 99464 requires that the newborn is expected to be in distress, and immediate stabilization of the baby right after delivery is required.
Stabilization of the newborn includes:
- Stimulation
- Initial drying
- Suctioning
- Apgar
- Visual inspection
- CPAP
- Blow-up
- Discussion with OB and/or parents
List of Newborn Care Services CPT Codes:
Below is the list of newborn care services (under E&M services) CPT Codes:
– 99460:
The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center.
– 99461:
The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, at a location other than a hospital or birthing center.
– 99462:
The provider performs the evaluation and management of a normal newborn on a day subsequent to the initial hospital evaluation.
– 99463:
The provider evaluates and manages the care of a normal newborn infant, typically immediately after birth, in a hospital or birthing center, through the time of discharge, or release, from the facility later the same day.
Medical coding for Pediatrics 2022:
Pediatrics CPT Code for preventive medicine services is 99381. This CPT code is for when the provider performs a well–baby visit for a child under the age of one.
The specific CPT Code range for pediatrics is 99466-99480. This code range is for Inpatient Neonatal Intensive Care Services, and Pediatric and Neonatal Critical Care Services fall under E&M services.
- CPT Code 99466:
- Critical care face-to-face services, during an interfacility transport of the critically ill or critically injured pediatric patient. It involves a time duration of the first 30-74 minutes.
- CPT Code 99467:
- “Add-on code” Critical care face-to-face services, during an interfacility transport of the critically ill or critically injured pediatric patient. It involves reporting an additional time of 30 minutes.
- CPT Code 99469:
- The provider evaluates and manages the subsequent care of a newborn or infant less than 28 days of age in a neonatal critical care setting after the first day.
- CPT Code 99476:
- The provider performs follow-up care for a critically ill child, ages two to five years, in an inpatient setting.
- 99477-99480: Initial and Continuing Intensive Care Services
- CPT Code 99478:
- The provider directs the care of a recovering low birthweight infant whose current weight is less than 1500 grams.
- CPT Code 99480:
- The provider directs the care of a recovering low birth weight infant, whose current weight is between 2501 and 5000 grams.
Coding Newborn charts: ICD-10:
Following are some of the common ICD-10 diagnosis codes for newborns. These codes include:
ICD-10 Codes for Liveborn infants according to the place of birth and type of delivery Z38:
Some of the ICD-10 2022 code for this category includes the following:
- Z38.1 Single liveborn infant, born outside hospital
- Z38.2 Single liveborn infant, unspecified as to the place of birth
- Z38.3 Twin liveborn infant, born in a hospital
- Z38.4 Twin liveborn infant, born outside hospital
- Z38.5 Twin liveborn infant, unspecified as to the place of birth
- Z38.7 Other multiple liveborn infants, born outside the hospital
- Z38.8 Other multiple liveborn infants, unspecified as to the place of birth
ICD-10 Codes for “Encounter for observation and evaluation of newborn for suspected diseases and conditions ruled out”:
This code category comprises the following:
ICD-10 Code Z05:
This category is to be used for newborns within the neonatal period (the first 28 days of life) who are suspected of having an abnormal condition. But this is without signs or symptoms and is ruled out after examination and observation.
ICD-10-CM Z05 is further classified into (but is not limited to):
- Z05.0 Observation and evaluation of newborn for suspected cardiac condition ruled out
- Z05.1 Observation and evaluation of newborn for suspected infectious condition ruled out
- Z05.2 Observation and evaluation of newborn for suspected neurological condition ruled out
- Z05.3 Observation and evaluation of newborn for suspected respiratory condition ruled out
- Z05.8 Observation and evaluation of newborn for other specified suspected condition ruled out
- Z05.9 Observation and evaluation of newborn for unspecified suspected condition ruled out
Newborn Critical Care:
Using the correct codes for reporting critical care for newborns is crucial for proper reimbursements. Some of the codes for pediatric critical care include:
- CPT Code: 99475 – Under Inpatient Neonatal and Pediatric Critical Care Services
The provider performs the initial evaluation and management of a critically ill child, ages two to five years, in an inpatient setting.
- CPT Code 99476 – Under Inpatient Neonatal and Pediatric Critical Care Services
The provider performs follow-up care for a critically ill child, ages two to five years, in an inpatient setting.
Frequently Asked Questions (FAQs)
1. Can you bill CPT 99464 & 99465 together?
CPT code 99464 (attendance at delivery) and CPT code 99465 (resuscitation) cannot be billed together on the same day. Following the proper coding guidelines ensures lesser errors in medical billing.
2. How can I code my newborns in hospital care?
Several CPT codes exist to bill newborn care services in a healthcare facility. These CPT codes can be 99460, 99461, 99463, etc. After the delivery, the baby is thoroughly examined for any signs of complications.
3. What does CPT code 99468 means?
This CPT Code falls under Inpatient Neonatal and Pediatric Critical Care Services and is maintained by the American Medical Association (AMA). CPT Code 99468 is for: “The provider evaluates and manages the initial care of a newborn or infant less than 28 days of age in a neonatal critical care setting.”
4. What does CPT code 99462 mean?
This CPT code falls under newborn care services in evaluation and management services. CPT code 99462 is maintained by the American Medical Association (AMA). The provider performs the evaluation and management of a normal newborn on a day subsequent to the initial hospital evaluation.
5. What is considered a newborn ICD-10?
When the birth episode of a newborn is to be reported, codes under the ICD 10 CM Z38 code must be used. Medical coders should be familiar with the coding guidelines and chapters of ICD-10-CM for proper coding.
6. What is the CPT code for newborns?
There are several newborn nursing billing codes. CPT Code 99460 is for Initial hospital or birthing center care, per day, for E/M of the normal newborn infant
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