Stay Away From Denials With This Lowdown on Newborn CCI Bundles

The new Correct Coding Initiative (CCI) 16.1 has an edit that family coders should take note of – more so if the practice tends to newborn patients.

Know the latest CCI 16.1 edit and gear up to observe it with this expert breakdown.

Take a look at Column 1 on these Hospital E / Ms. As per the latest CCI edits , these codes are in column 1 of the mutually exclusive (ME) edits:

  • 99231 (Subsequent hospital care, per day, for the E / M of a patient, which needs at least two of these three key components: a problem focused interval history; a problem focused exam; medical decision making that's straightforward or of low complexity. ..)
  • 99232 (… an expanded problem centric interval history; an expanded problem focused examination; and medical decision making of moderate complexity …)
  • 99233 (… a comprehensive interval history; a detailed examination; and medical decision making of high complexity …).

Column 2 of these edits covers these codes:

  • 99460 (Initial hospital or birth center care, per day, for E / M of normal newborn infant)
  • 99461 (Initial care, per day, for E / M of normal newborn infant seen in other than hospital or birth center)
  • 99462 (Subsequent hospital care, per day. For E / M of normal newborn).

Translation: An FP may not report both normal newborn care and consequent hospital care for a newborn on the same DOS (date of service). If the FP carries out normal newborn services (99460-99462) on the same date and the newborn later becomes ill and gets a confidential hospital care (99231-99233), you should only go for a code from the 99231-99233 code set, according to Kent Moore, manager of health care financing and delivery systems for the American Academy of Family Physicians (AAFP) in Leawood, Kan.

The services are ME as the newborn care codes (99460-99463) are for "normal" newborns (for instance newborns without medical problems); while the specified hospital care codes (99231-99233) are for problem-oriented services, according to Moore.

As both sets of services are designated as "per day," medical coders must select between them for a given patient on a given date. "Consistent with the ME nature of these services, Correct Coding Initiative does not permit a modifier to override the edits," continues Moore.

Bottom line : You should never report 99460-99262 and 99231-99233 for the same patient on the same date of service.