Newborn Coding
At Birth All newborn billing must be submitted on a separate superbil from the mother. Newborn is the patient.
Common ICD-10
Z38.00 - Newborn Born Vaginally
Z38.1 - Newborn born outside of facility (home)
For more detailed or additional ICD-10 diagnoses coding, please reference any AMA certified coding software or look-up tools and manuals. Please, do NOT use google or other internet search engines for coding.
99460 - Initial hospital or birthing center care, per day, for E/M of normal newborn infant.
Used when newborn is born in birthing center or hospital and is NOT discharged same day. One code billed in each 24hr period. Includes professional services such as CCHD screening at newborn exam.
99463 - Initial hospital or birthing center care, per day, for E/M of normal newborn infant admitted and discharged on the same date.
Used when newborn is born in birthing center or hospital and is discharged same day. One code allowed for each newborn. Includes professional services such as CCHD screening at newborn exam.
99461 - Initial care, per day, for evaluation and management of normal newborn infant seen in other than hospital or birthing center (i.e home).
Used when Newborn is born at home (12). One code billed per newborn. Includes professional services such as CCHD screening.
99464 - Attendance at delivery (when requested by the delivering/primary provider) and initial stabilization of newborn.
Used when a qualified secondary provider is present for newborn care. Billed under the newborn. Includes CCHD and newborn exam when billed under the same provider on the same date of service. Medicaid does not reimburse when billed under a CDM or CPM.
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.
Includes newborn exam unless newborn exam is billed with modifier(25) for significantly seperate E/M level visit performed by the same provider on the same date of service. Includes CCHD.
Newborn less than 8 days old.
Common ICD-10
Z00.110 - Examination of Newborn Under 8 days old
Z13.228 - Encounter for Metabolic Screening (Needs S3620 Procedure Code)
P92.2 - SLOW FEEDING OF NEWBORN
P92.5 - NEONATAL DIFFICULTY IN FEEDING AT BREAST
P92.6 - FAILURE TO THRIVE IN NEWBORN
For more detailed or additional ICD-10 diagnoses coding, please reference any AMA certified coding software or look-up tools and manuals. Please, do NOT use google or other internet search engines for coding.
S3620 - PKU/NEWBORN METABOLIC SCREENING (Requires Z13.228 diagnoses code)
Evaluation/Management Visit Coding - If you billed for a newborn exam or care at birth, your first E/M visit will be as an established patient.
Established Patient
99211 - LEVEL 1 Established Patient, Office or other Outpatient Visit, Minimal
99212 - LEVEL 2 Established Patient, Office or other Outpatient Visit, Problem Focused
99213 - LEVEL 3 Established Patient, Office or other Outpatient Visit, Expanded Problem Focused
99214 - LEVEL 4 Established Patient, Office or other Outpatient Visit, Detailed
99215 - LEVEL 5 Established Patient, Office or other Outpatient Visit, Comprehensive
99347 - LEVEL 1 Established Patient, Home Visit, Problem Focused
99348 - LEVEL 2 Established Patient, Home Visit, Straightforward
99349 - LEVEL 3 Established Patient, Home Visit, Detailed
99350 - LEVEL 4 Established Patient, Home Visit, Comprehensive - Not Reimbursed by medicaid for CDMs or CPMs
New Patient
99381 - New Patient, Initial Comprehensive Preventative Medicine (less than 1 year of age) - Not Reimbursed by medicaid for CDMs or CPMs
99201 - LEVEL 1 New Patient, Office or other Outpatient Visit, Problem Focused
99202 - LEVEL 2 New Patient, Office or other Outpatient Visit, Expanded Problem Focused
99203 - LEVEL 3 New Patient, Office or other Outpatient Visit, Detailed
99204 - LEVEL 4 New Patient, Office or other Outpatient Visit, Comprehensive
99205 - LEVEL 5 New Patient, Office or other Outpatient Visit, Complex
99341 - LEVEL 1 New Patient, Home Visit, Problem Focused
99342 - LEVEL 2 New Patient, Home Visit, Expended Problem Focused
99343 - LEVEL 3 New Patient, Home Visit, Detailed
99344 - LEVEL 4 New Patient, Home Visit, Comprehensive
99345 - LEVEL 5 New Patient, Home Visit, Complex - Not Reimbursed by medicaid for CDMs or CPMs
Newborn 8-28 days old
Common ICD-10
Z00.111 - Examination of Newborn 8-28 days old
P92.2 - SLOW FEEDING OF NEWBORN
P92.5 - NEONATAL DIFFICULTY IN FEEDING AT BREAST
P92.6 - FAILURE TO THRIVE IN NEWBORN
For more detailed or additional ICD-10 diagnoses coding, please reference any AMA certified coding software or look-up tools and manuals. Please, do NOT use google or other internet search engines for coding.
Evaluation/Management Visit Coding - If you billed for a newborn exam or care at birth, your first E/M visit will be as an established patient.
Established Patient
99211 - LEVEL 1 Established Patient, Office or other Outpatient Visit, Minimal
99212 - LEVEL 2 Established Patient, Office or other Outpatient Visit, Problem Focused
99213 - LEVEL 3 Established Patient, Office or other Outpatient Visit, Expanded Problem Focused
99214 - LEVEL 4 Established Patient, Office or other Outpatient Visit, Detailed
99215 - LEVEL 5 Established Patient, Office or other Outpatient Visit, Comprehensive
99347 - LEVEL 1 Established Patient, Home Visit, Problem Focused
99348 - LEVEL 2 Established Patient, Home Visit, Straightforward
99349 - LEVEL 3 Established Patient, Home Visit, Detailed
99350 - LEVEL 4 Established Patient, Home Visit, Comprehensive - Not Reimbursed by medicaid for CDMs or CPMs
New Patient
99381 - New Patient, Initial Comprehensive Preventative Medicine (less than 1 year of age) - Not Reimbursed by medicaid for CDMs or CPMs
99201 - LEVEL 1 New Patient, Office or other Outpatient Visit, Problem Focused
99202 - LEVEL 2 New Patient, Office or other Outpatient Visit, Expanded Problem Focused
99203 - LEVEL 3 New Patient, Office or other Outpatient Visit, Detailed
99204 - LEVEL 4 New Patient, Office or other Outpatient Visit, Comprehensive
99205 - LEVEL 5 New Patient, Office or other Outpatient Visit, Complex
99341 - LEVEL 1 New Patient, Home Visit, Problem Focused
99342 - LEVEL 2 New Patient, Home Visit, Expended Problem Focused
99343 - LEVEL 3 New Patient, Home Visit, Detailed
99344 - LEVEL 4 New Patient, Home Visit, Comprehensive
99345 - LEVEL 5 New Patient, Home Visit, Complex - Not Reimbursed by medicaid for CDMs or CPMs
Child 28 days - one year
Common ICD-10
Z00.129 - ENCOUNTER FOR ROUTINE CHILD HEALTH EXAMINATION WITHOUT ABNORMAL FINDINGS
Z00.121 - ENCOUNTER FOR ROUTINE CHILD HEALTH EXAMINATION WITH ABNORMAL FINDINGS
Age range not reimbursed by medicaid for CDMs or CPMs
For more detailed or additional ICD-10 diagnoses coding, please reference any AMA certified coding software or look-up tools and manuals. Please, do NOT use google or other internet search engines for coding.
Evaluation/Management Visit Coding - If you billed for a newborn exam or care at birth, your first E/M visit will be as an established patient.
Established Patient
99211 - LEVEL 1 Established Patient, Office or other Outpatient Visit, Minimal
99212 - LEVEL 2 Established Patient, Office or other Outpatient Visit, Problem Focused
99213 - LEVEL 3 Established Patient, Office or other Outpatient Visit, Expanded Problem Focused
99214 - LEVEL 4 Established Patient, Office or other Outpatient Visit, Detailed
99215 - LEVEL 5 Established Patient, Office or other Outpatient Visit, Comprehensive
99347 - LEVEL 1 Established Patient, Home Visit, Problem Focused
99348 - LEVEL 2 Established Patient, Home Visit, Straightforward
99349 - LEVEL 3 Established Patient, Home Visit, Detailed
99350 - LEVEL 4 Established Patient, Home Visit, Comprehensive - Not Reimbursed by medicaid for CDMs or CPMs
New Patient
99381 - New Patient, Initial Comprehensive Preventative Medicine (less than 1 year of age) - Not Reimbursed by medicaid for CDMs or CPMs
99201 - LEVEL 1 New Patient, Office or other Outpatient Visit, Problem Focused
99202 - LEVEL 2 New Patient, Office or other Outpatient Visit, Expanded Problem Focused
99203 - LEVEL 3 New Patient, Office or other Outpatient Visit, Detailed
99204 - LEVEL 4 New Patient, Office or other Outpatient Visit, Comprehensive
99205 - LEVEL 5 New Patient, Office or other Outpatient Visit, Complex
99341 - LEVEL 1 New Patient, Home Visit, Problem Focused
99342 - LEVEL 2 New Patient, Home Visit, Expended Problem Focused
99343 - LEVEL 3 New Patient, Home Visit, Detailed
99344 - LEVEL 4 New Patient, Home Visit, Comprehensive
99345 - LEVEL 5 New Patient, Home Visit, Complex - Not Reimbursed by medicaid for CDMs or CPMs