Neonatology involves the usage of complex codes and modifiers to make sure no claim denial occurs. Unlike adult medicine, neonatology billing has several complexities, including important cases, multiple patient encounters, and a never-ending code list which looks identical but means different things. Moreover, it is shaped by CMS reimbursement updates, payer-specific rules, and ongoing ICD and CPT coding changes. The majority of neonatologists often fail to stay updated with the ever-changing regulations, thus facing delayed payments, underpayments or denials which can affect the revenue process. As the healthcare staff have to take care of their patients, that’s why it can be a feasible option to outsource neonatology billing services. They know all the complex nuances of the PA process and make sure clinics get the right reimbursement possible.
Neonatology Billing Guidelines
The rules of neonatology billing significantly differ from standard pediatric billing. Here are some of the latest guidelines of neonatology billing:
- Age-specific coding: The neonatal codes apply to the infants who are under 28 days old. However, once the infant grows old, the clinics need to shift to pediatric critical care or subsequent care codes.
- Per-day billing: Neonatology services are billed on a per day basis rather than per patient visit.
- No double-dipping: Only one clinic can bill a single day for a single patient under all the neonatal critical care. However, if the multiple providers of one single group see the baby, only one claim is needed to be submitted.
- Intensive versus critical care: Critical care codes used for sick neonates require life-sustaining interventions. Moreover, the intensive care codes are used for less acute but high-level care.
Common Neonatology Billing CPT Codes
| Code Range | Description | When to Use |
|---|---|---|
| 99468 | Per day neonatal initial critical care | The first day of Neonate critical care, usually less than 28 days old |
| 99469 | Subsequent neonatal critical care per day | Each following day of critical care |
| 99477 | Neonate intensive care and initial hospital care | Used when the baby needs intensive care but is not critically ill |
| 99478–99480 | Subsequent intensive care on every day | Applicable for neonates weighing 1500 grams to 2500 grams |
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Top Medical Coding Services for Your Practice
ICD Codes
| Category | ICD Codes | Notes |
|---|---|---|
| Prematurity | P07.01 to P07.26 | Unspecified if possible |
| Respiratory | P22.0, P28.5 | P28.5 needs strong clinical proof |
| Infections | P36.0, P39.9 | Use organism-specific first |
| Jaundice | P59.0, P59.9 | P59.0 only if prematurity-related |
| Hypoglycemia | P70.4 | Not P70.1 |
Common Neonatology Billing Denial Reasons
Despite giving best efforts, neonatology claims get denied frequently. However, the billing teams report some of these top denial reasons such as:
- Missing weight or gestational age: The payers may not approve intensive care codes without all these details.
- Incorrectly selecting CPT codes: It includes using 99469 on day one, instead of 99468.
- Duplicate billing: It is where more than one clinic is billing for Neonatal critical care on the same day.
- Mismatch between CPT and ICD codes: Billing for neonatal critical care but linking to normal newborn ICD codes.
- Lack in medical necessity: If the patient charts doesn’t justify why the intensive care is required, payers may deny the claim.
How the Outsourced Neonatology Billing Company Helps?
The outsourced experts stay updated with all the latest CPT, ICD, and HCPCS codes to make sure no claim denial occurs. Moreover, they also know all the complex nuances of the prior authorization process by verifying the patient’s insurance eligibility, collecting important documents, and then submitting PA requests. However, the in-house team comes with a high cost because you need to train them and also buy expensive office space for them. On the contrary, the outsourced services don’t need training or any separate office space. Finally, these experts know how to work with the clinic’s EHR system to protect patient data, and Electronic Prior Authorization (ePA) to submit claims electrically.
Check out experts who help with general neonatology, neonatal intensive care, therapy, transport, and follow-up billing. These experts also provide end-to-end RCM services starting from patient entry to payment posting. These experts also provide customizable support for the RCM process and can save around 80% of operational costs. These companies have dedicated account managers at no extra cost and are 100% HIPAA compliant. These companies work with 99.9% accuracy and can provide you with 100’s of references.
They have the best infrastructure setup according to the client’s needs. It has been observed that these experts work with several specialties such as DME, gastroenterology, urgent care, infusion, cardiology, and many more. Furthermore, these experts also help with other RCM solutions such as medical billing, eligibility verification, medical coding, accounts receivable, denial management, and many more. These experts don’t have any binding contract with 30-day exit clause and have around 97% of the highest collection rate. They also provide 10% buffer resources and dedicated employees having US phone numbers. These services provide free account supervisors and real-time audits along with less than two days of turnaround time. So, if you want to streamline your billing process, it can be a feasible option to outsource neonatology billing solutions in that matter.