Attendance and delivery

Our physician is asked to attend a delivery (code 99464) for a elective C-section, , twins are delivered. Is the Attendance and Delivery billed twice for each baby delivered?

re: ATTENDANCE AND DELIVERY

Not in my opinion

re: ATTENDANCE AND DELIVERY

I have the same opinion; any suggestions on how to explain it to my superiors. Or better yet maybe some written information (because if it isn’t documented it did not happen) LOL. I am new at coding inpatient hospital codes for a pediatric hospitalist. I would appreciate all the help I can get. Thanks for your quick response.

re: ATTENDANCE AND DELIVERY

Rethinking this scenario. If the initial stabilization is performed on each infant, I do believe it can be billed for each. In box 19 put twin A and Twin B. I believe Medicaid in some states allow this. Track your reimbursement. May want to poll your private payers. I am talking about code 99464

re: ATTENDANCE AND DELIVERY

re: ATTENDANCE AND DELIVERY

Now you have opened another can of worms. If stabilization is required, shouldn’t we be billing the procedure codes done to stabilize the child, (excluding delivery/birth room resuscitation [99465])? Now that I have reread CPT® code 99464 it appears to represent an all inclusive code; anything that is done to stabilize the patient is represented in 99464. Is that your interpretation? And in the scenario where both infants are fine would you bill it per child?

re: ATTENDANCE AND DELIVERY

I know, coders open cans of worms every day, part of what we do. Physicians not managing labor and delivery or assisting/performing a cesarean delivery may be asked by the physician who is attending the mother to provide other services such as standby during cesarean or high-risk delivery, attendance at delivery with initial stabilization of the newborn, or newborn resuscitation in the delivery or birthing room.
When the physician managing the patient's delivery requests your attendance at the delivery and you provide initial stabilization of the newborn, this may be reported with code 99464. Codes for standby (99360) and delivery or birthing room resuscitation (99465) may not be reported in conjunction with code 99464.
Example payer policy: https://www.msbcbs.com/gapfill/G-1-004.html. Each payer sets the allowances. The care rendered by code 99464 includes: – Initial drying, Stimulation, Suctioning, Blow-by oxygen, CPAP, Assigning Apgars. Some payers base payment on physician specialty: BCBSD: Attendance at delivery is paid for high risk maternity or C-sections at contracted hospitals. Specialties covered are neonatology, pediatrics, and family practice.
http://www.bcbsde.com/ProviderPolicies/public_site/10.01.02A_Attendance_at_Delivery.htm

re: ATTENDANCE AND DELIVERY

As a pediatrician, if I'm called to a twin delivery, there are 2 patients and I will submit 2 charges (99464). If I have to do anything else, it's 99465, newborn resuscitation.

As always, the physician's documentation needs to be complete so the coder can do his/her job, i.e. why was I called to the delivery, did I have to resuscitate the baby, etc.

It always hacks me off that there is a standby code (I'm waiting around for a delivery) but nobody pays it.

As a side note, occasionally when I see parents for a prenatal visit, they will ask me to be in attendance at the delivery 'just in case something happens'. I then have the conversation that they may see the pediatrician on call, and if the baby is normal and has no problems, they will still get charged.