Newborn Care Services 101

Newborn Baby

I hadn’t really thought about it before. Newborns are the only patients that are admitted to the hospital that may not have a medical condition and may transition in a normal and healthy way, according to the AAP (American Academy of Pediatrics).

Newborns typically fall into one of four clinical situations

  1. Normal Newborn
  2. Sick Newborn
  3. Intensive Care Needs
  4. Critical Care Needs

Normal Newborn Care Services

According to the American Academy of Pediatrics, a normal newborn is defined as:

  • Transitions to life in the usual manner
  • May require delivery room intervention, but is normal after transition
  • May require testing or follow-up (bilirubin, CBC, or culture, etc.)
  • Significant intervention not required
  • May be observed, but without signs/symptoms currently
  • Preterm with no special care required
  • May be present with sick contacts (mother, twin, sibling)
  • May have some condition described by ICD-10, but is still normal

Newborn Care Services are described in CPT codes 99460 – 99463.

“Sick” Newborn Care Services

CPT states that initiation of hospital inpatient or observation care for the ill neonate NOT requiring intensive care (defined as requiring intensive observation, frequent interventions, and other intensive care services), see codes 99221-99223.

Newborn Intensive Care Services

Intensive Care Services code set (99477 – 99480) is appropriate for use when a child is NOT critically ill, but still requires intensive observation, frequent interventions, and other intensive care services. Code selection is based on the newborn’s condition (needing intensive services), age, and/or weight.

Newborn Critical Care Services

CPT describes “per day” neonatal critical care codes by age:

  • 99468 – Initial Inpatient Neonatal Critical Care, per day, for the evaluation and management of a critically ill neonate, 28 days or younger
  • 99469 – Subsequent Inpatient Neonatal Critical Care, per day, for the evaluation and management of a critically ill neonate, 28 days or younger
  • 99471 – Initial Inpatient Neonatal Critical Care, per day, for the evaluation and management of a critically ill neonate, 29 days – 24 months of age
  • 99472 – Subsequent Inpatient Neonatal Critical Care, per day, for the evaluation and management of a critically ill neonate, 29 days – 24 months of age

Critical Care Services performed during transport may be reported using 99466 – 99486.

Pediatric Critical Care Services (99475, 99476 and 99291, 99292) will be described in a separate article apart from Newborn Care Services.

Understand that a newborn can be on different ends of the spectrum of a diagnosis. Your documentation paints the picture that substantiates the need for newborn sick, intensive, or critical care services. Let’s take a look at the possible scenarios for hypoglycemia.

Hypoglycemia

Sick Care – If glucose levels are stable and do not require frequent monitoring or adjustment hospital care codes (99221-99233) may be more suitable.

Intensive Care – If infants require continuous intravenous glucose supplementation with frequent monitoring and multiple adjustments of IV glucose rates or if a central venous line (e.g., umbilical venous line) was placed to accommodate high concentrations of glucose, intensive care codes (99477-99480) may be used.

Critical Care – Persistent hypoglycemia (often due to hyperinsulinism) in the setting of elevated glucose infusion rates requiring the addition of diazoxide or glucagon may justify critical care coding (99468-99472).

We have prepared a presentation for the Pediatric Step-Down Team (ppt) (handouts).  Additionally, we put together the Newborn Care Services tip sheet to compliment this training.

Other Resources

AAP:  Daily Code (Global or Per Diem) Critical Care Guidance

(NEW!) February 2024 – Concurrent Care CHI Presentation (ppt) (tip sheet) (Recording)

If you would like more information, please reach out to [email protected], [email protected], or [email protected].