Delivery with Resuscitation Coding Correction

The Section on Perinatal Pediatrics:

There are two codes which describe attendance at delivery. The first, 99464, by definition includes attendance at delivery when requested by the delivering physician and initial stabilization of the newborn. The second, 99465, by definition includes delivery/birthing room resuscitation, provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output.

Both codes can be reported in conjunction with 99460 (normal newborn care), 99477 (initial hospital care for the evaluation and management of the neonate, 28 days or less, who requires intensive observation, frequent interventions, and other intensive care services), and 99468 (initial inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or less).

Unfortunately, there is an error in CPT 2009 (page 33) which states that 99465 cannot be used in conjunction with 99460, 99468, and 99477. The AMA has corrected this mistake in a bulletin entitled "Corrections Document CPT 2009". However, many payers may look to CPT 2009 with this incorrect information and deny your codes for attendance at delivery with resuscitation.

Make sure that your billing staff is aware of this error and monitors denials. It would also be prudent to alert your payers of this error before the denials begin. As you know, once a claim is denied, it takes a long period of time for reversal to occur.

If your have any questions regarding the above, contact the member of the Coding Trainer's Committee in your district.

This information was provided by the Coding Trainer's Committee - AAP Section on Perinatal Pediatrics