Medical Billing Dilemma- Changing Newborn Status

Medical Billing Dilemma – Changing Newborn Status

The well-being of newborns can change instantly, which intern, changes their medical billing. Newly born babies are very susceptible to illnesses. Their bodies are not used to functioning outside the uterus. They develop breathing problems, heart conditions, illnesses, skin rashes, etc. Many medical billers have incorrectly coded these evaluations. In order to receive correct reimbursement for newborns, it is important to know how to do medical billing for same-day visits for different diagnoses.

When a baby is born, it may be considered a well baby. They physician does an exam and the baby is sent to the nursery. Let’s say that two hours later the baby develops a breathing problem. The same physician comes in and does another exam on the same day. It is entirely appropriate and mandatory to report these two evaluation and management visits separately. They were two separate visits and require separate medical billing and reimbursement.

The initial well baby E/M will be coded with the medical billing code 99431. It is important to remember to code any subsequent care as 99231-99233. Many medical billing personnel will incorrectly bill with initial hospital codes like 99221-99223. They should be treated as subsequent evaluations. The initial evaluation was done when the baby was born.

To help payers quickly understand your medical billing, you should attach a modifier to your subsequent care code. Modifier 25 means, a significant separately identifiable service provided during the preventative visit. Also, to help the payers distinguish the medical billing, be sure to attach the correct diagnoses to the correct CPT code.

With a little bit of time and effort, newborn medical billing is as simple as pie. Just remember that if a newborn is seen twice during a day for two different reasons, by all means, medical billing can be done separately.

View all Articles by: Melissa Clark, CCS-P