99460- 99465 Alert: Protect Your Hospital Well Care Pay With EOB Check

Got an EOB, pediatric coders? Read it carefully.

Are you receiving one-third less for 99460- 99465? Here’s what to do.

You know insurers aren’t Flash Gordons when it comes to implementing coding changes but recent cuts on the normal newborn hospital care CPT 2009 codes take the cake.

“Monitor your statements to make sure you’re getting paid appropriately for 99460-99465,” says Richard Tuck, MD, FAAP, pediatrician at PrimeCare of Southeastern Ohio in Zanesville. “We found that our Medicaid was paying us significantly less (about one-third less) for the new codes than the old codes (99431-99440).”

Why: Medicaid has since corrected the administrative error that resulted from not realizing that the 99431-99440 to 99460-99465 code revisions involved no descriptor change, but were a direct crosswalk. When the administrator inputted the codes, she applied a standard new codededuction. Because the code changes reflected only renumbering to make room for more codes as needed, the fee change does not apply.

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“Pediatric practices need to be on top of this,” Tuck stresses. Although the codes have been out since January 2009, it doesn’t mean you’ve started using them, or have been using them for that long – so you might not yet be aware of a pay cut. Some systems have both the old codesand the new codes (99431-99460) active and plan on deleting the 2008 CPT set at some later time. Other plans started requiring the new codes immediately after their CPT Jan. 1, 2009, HIPAA compliant effective date.

Do this: Be in touch with each payer. Don’t assume that the plan will automatically apply the same fees to the new set as to the old set. But they should be exactly the same!

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