Neonatology is a subspecialty of pediatrics that consists of the medical care of newborn infants, especially the ill or premature newborn. It is a hospital-based specialty, usually delivered in neonatal intensive care units (NICUs). The principal patients of neonatologists are newborn infants who are ill or require special medical care due to:

  • Prematurity
  • Low birth weight
  • Intrauterine growth restriction
  • Congenital malformations or disabilities
  • Sepsis
  • Pulmonary hypoplasia
  • Birth asphyxia

A neonatologist is responsible for the life and healthy recovery of the smallest human beings who pose the most extensive & complicated challenges. Partnering or Outsourcing the management of your revenue cycle to an offshore company like MBW lessens the burden of streamlining the hospital’s financial aspect.

Medical Billing & Coding Services Expertise in Neonatology

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At MBW, we have a client base that spans across all 50 states, covers a wide range of hospitals with NICUs, physician practices, and medical billing companies. Our coders are proficient in ICD-9/10, CPT, HCPCS coding guidelines provided by CMS and AMA and certified by the American Academy of Professional Coders (AAPC). It would be fair to state that we have a decade of experience in neonatal billing & coding. We also specialize in LEVEL III NICU billing & coding.

Applying best practices for Neonatal Billing & Coding Services

We apply the correct codes for both E/M services offered to a healthy newborn vs. NICU codes for newborns with congenital disabilities. To avoid rejections & re-submissions from the clearinghouse, our team submits clean claims the first time itself and abides by the policies, rules & regulations of all payers. Our coding team employs its extensive knowledge and facilitates the proper use of modifiers to avoid denials.

Best practices for neonatal coding:

Physicians should include Newborn Care Services codes for evaluation and management (E/M) services provided to normal newborns in the first days of life before hospital discharge. Codes for initial care of the normal newborn include:

99460 Initial hospital or birthing center care, per day, for E/M of a normal newborn infant
99461 Initial care per day, for E/M of normal newborn infant seen in other than hospital or birthing center
99463 Initial hospital or birthing center care, per day, for E/M of a normal newborn infant, admitted and discharged on the same date

Codes 99478-99480 describe the intensive care provided to evaluate and manage the recovering low or very low birth weight infant. The code is selected based upon the present bodyweight of the infant as below:

99478 Present bodyweight less than 1500 grams
99479 Present bodyweight of 1500-2500 grams
99480 Present bodyweight of 2501-5000 grams

Inpatient Neonatal Critical Care

The initial day of critical care for evaluating and managing a critically ill neonate, 28-days of age or less is reported with code 99468. We report this code for only one physician. If another physician provides critical care services to the neonate on the same date, we report the services provided using critical care service codes 99291-99292.

Subsequent days of critical care to the critically ill neonate are reported per day with code 99469. As with the initial critical care, code 99469 is used to report only for one physician on a given date.

Benefits of our Neonatology Billing and Coding Services

We bring excellence, knowledge, and accuracy in neonatal billing and coding services while building a revenue cycle devoid of defects for your hospital. Our team strives to introduce a friction-free billing, coding, claim submission, and payment posting process. We ensure persistent accounts receivable follow-up and prior authorization to avoid claim denials. Medical Billing Wholesalers helps hospitals offer excellent care for their little patients, focusing on improving their administrative & financial excellence. We bring you a team of specialists who are:

  • Certified by The American Association of Professional Coders (AAPC) and has received training in most common Medical Coding Software
  • Successful in processing medical claims with commercial insurance companies including UHC, WellPoint, Aetna, Humana BCBS, and Anthem, and government payers such as Medicare
  • Successful in working with Medicare and understand state-specific Medicaid Policies
  • Experts in reducing costs and helping you achieve improved clinical and operational efficiency

Our clients typically see an improvement in revenue by 20% and a reduction in denials by a minimum of 15%. We achieve this by applying our expertise and process rigor.