Newborn Coding

At Birth All newborn billing must be submitted on a separate superbil from the mother. Newborn is the patient. 

Common ICD-10

Z38.00 - Newborn Born Vaginally 

Z38.1 - Newborn born outside of facility (home)

For more detailed or additional ICD-10 diagnoses coding, please reference any AMA certified coding software or look-up tools and manuals. Please, do NOT use google or other internet search engines for coding. 

99460 - Initial hospital or birthing center care, per day, for E/M of normal newborn infant.

Used when newborn is born in birthing center or hospital and is NOT discharged same day. One code billed in each 24hr period. Includes professional services such as CCHD screening at newborn exam. 

99463 - Initial hospital or birthing center care, per day, for E/M of normal newborn infant admitted and discharged on the same date. 

Used when newborn is born in birthing center or hospital and is discharged same day. One code allowed for each newborn. Includes professional services such as CCHD screening at newborn exam. 

99461 - Initial care, per day, for evaluation and management of normal newborn infant seen in other than hospital or birthing center (i.e home). 

Used when Newborn is born at home (12). One code billed per newborn. Includes professional services such as CCHD screening. 

99464 - Attendance at delivery (when requested by the delivering/primary provider) and initial stabilization of newborn.

Used when a qualified secondary provider is present for newborn care. Billed under the newborn. Includes CCHD and newborn exam when billed under the same provider on the same date of service. Medicaid does not reimburse when billed under a CDM or CPM. 

99465 - Delivery/Birthing room resuscitation, provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output. 

Includes newborn exam unless newborn exam is billed with modifier(25) for significantly seperate E/M level visit performed by the same provider on the same date of service. Includes CCHD. 

Newborn less than 8 days old. 

Common ICD-10

Z00.110 - Examination of Newborn Under 8 days old

Z13.228 - Encounter for Metabolic Screening (Needs S3620 Procedure Code)

P92.2 - SLOW FEEDING OF NEWBORN

P92.5 - NEONATAL DIFFICULTY IN FEEDING AT BREAST

P92.6 - FAILURE TO THRIVE IN NEWBORN

For more detailed or additional ICD-10 diagnoses coding, please reference any AMA certified coding software or look-up tools and manuals. Please, do NOT use google or other internet search engines for coding. 

S3620 - PKU/NEWBORN METABOLIC SCREENING (Requires Z13.228 diagnoses code) 

Evaluation/Management Visit Coding - If you billed for a newborn exam or care at birth, your first E/M visit will be as an established patient. 

Established Patient

99211 - LEVEL 1 Established Patient, Office or other Outpatient Visit, Minimal

99212 - LEVEL 2 Established Patient, Office or other Outpatient Visit, Problem Focused

99213 - LEVEL 3 Established Patient, Office or other Outpatient Visit, Expanded Problem Focused

99214 - LEVEL 4 Established Patient, Office or other Outpatient Visit, Detailed

99215 - LEVEL 5 Established Patient, Office or other Outpatient Visit, Comprehensive

99347 - LEVEL 1 Established Patient, Home Visit, Problem Focused

99348 - LEVEL 2 Established Patient, Home Visit, Straightforward

99349 - LEVEL 3 Established Patient, Home Visit, Detailed

99350 - LEVEL 4 Established Patient, Home Visit, Comprehensive - Not Reimbursed by medicaid for CDMs or CPMs 

New Patient 

99381 - New Patient, Initial Comprehensive Preventative Medicine (less than 1 year of age) - Not Reimbursed by medicaid for CDMs or CPMs 

99201 - LEVEL 1 New Patient, Office or other Outpatient Visit, Problem Focused

99202 - LEVEL 2 New Patient, Office or other Outpatient Visit, Expanded Problem Focused

99203 - LEVEL 3 New Patient, Office or other Outpatient Visit, Detailed

99204 - LEVEL 4 New Patient, Office or other Outpatient Visit, Comprehensive

99205 - LEVEL 5 New Patient, Office or other Outpatient Visit, Complex

99341 - LEVEL 1 New Patient, Home Visit, Problem Focused

99342 - LEVEL 2 New Patient, Home Visit, Expended Problem Focused

99343 - LEVEL 3 New Patient, Home Visit, Detailed

99344 - LEVEL 4 New Patient, Home Visit, Comprehensive

99345 - LEVEL 5 New Patient, Home Visit, Complex - Not Reimbursed by medicaid for CDMs or CPMs 

Newborn 8-28 days old

Common ICD-10

Z00.111 - Examination of Newborn 8-28 days old

P92.2 - SLOW FEEDING OF NEWBORN

P92.5 - NEONATAL DIFFICULTY IN FEEDING AT BREAST

P92.6 - FAILURE TO THRIVE IN NEWBORN

For more detailed or additional ICD-10 diagnoses coding, please reference any AMA certified coding software or look-up tools and manuals. Please, do NOT use google or other internet search engines for coding. 

Evaluation/Management Visit Coding - If you billed for a newborn exam or care at birth, your first E/M visit will be as an established patient. 

Established Patient

99211 - LEVEL 1 Established Patient, Office or other Outpatient Visit, Minimal

99212 - LEVEL 2 Established Patient, Office or other Outpatient Visit, Problem Focused

99213 - LEVEL 3 Established Patient, Office or other Outpatient Visit, Expanded Problem Focused

99214 - LEVEL 4 Established Patient, Office or other Outpatient Visit, Detailed

99215 - LEVEL 5 Established Patient, Office or other Outpatient Visit, Comprehensive

99347 - LEVEL 1 Established Patient, Home Visit, Problem Focused

99348 - LEVEL 2 Established Patient, Home Visit, Straightforward

99349 - LEVEL 3 Established Patient, Home Visit, Detailed

99350 - LEVEL 4 Established Patient, Home Visit, Comprehensive - Not Reimbursed by medicaid for CDMs or CPMs 

New Patient 

99381 - New Patient, Initial Comprehensive Preventative Medicine (less than 1 year of age) - Not Reimbursed by medicaid for CDMs or CPMs 

99201 - LEVEL 1 New Patient, Office or other Outpatient Visit, Problem Focused

99202 - LEVEL 2 New Patient, Office or other Outpatient Visit, Expanded Problem Focused

99203 - LEVEL 3 New Patient, Office or other Outpatient Visit, Detailed

99204 - LEVEL 4 New Patient, Office or other Outpatient Visit, Comprehensive

99205 - LEVEL 5 New Patient, Office or other Outpatient Visit, Complex

99341 - LEVEL 1 New Patient, Home Visit, Problem Focused

99342 - LEVEL 2 New Patient, Home Visit, Expended Problem Focused

99343 - LEVEL 3 New Patient, Home Visit, Detailed

99344 - LEVEL 4 New Patient, Home Visit, Comprehensive

99345 - LEVEL 5 New Patient, Home Visit, Complex - Not Reimbursed by medicaid for CDMs or CPMs 

Child 28 days - one year

Common ICD-10

Z00.129 - ENCOUNTER FOR ROUTINE CHILD HEALTH EXAMINATION WITHOUT ABNORMAL FINDINGS

Z00.121 - ENCOUNTER FOR ROUTINE CHILD HEALTH EXAMINATION WITH ABNORMAL FINDINGS

Age range not reimbursed by medicaid for CDMs or CPMs 

For more detailed or additional ICD-10 diagnoses coding, please reference any AMA certified coding software or look-up tools and manuals. Please, do NOT use google or other internet search engines for coding. 

Evaluation/Management Visit Coding - If you billed for a newborn exam or care at birth, your first E/M visit will be as an established patient. 

Established Patient

99211 - LEVEL 1 Established Patient, Office or other Outpatient Visit, Minimal

99212 - LEVEL 2 Established Patient, Office or other Outpatient Visit, Problem Focused

99213 - LEVEL 3 Established Patient, Office or other Outpatient Visit, Expanded Problem Focused

99214 - LEVEL 4 Established Patient, Office or other Outpatient Visit, Detailed

99215 - LEVEL 5 Established Patient, Office or other Outpatient Visit, Comprehensive

99347 - LEVEL 1 Established Patient, Home Visit, Problem Focused

99348 - LEVEL 2 Established Patient, Home Visit, Straightforward

99349 - LEVEL 3 Established Patient, Home Visit, Detailed

99350 - LEVEL 4 Established Patient, Home Visit, Comprehensive - Not Reimbursed by medicaid for CDMs or CPMs 

New Patient 

99381 - New Patient, Initial Comprehensive Preventative Medicine (less than 1 year of age) - Not Reimbursed by medicaid for CDMs or CPMs 

99201 - LEVEL 1 New Patient, Office or other Outpatient Visit, Problem Focused

99202 - LEVEL 2 New Patient, Office or other Outpatient Visit, Expanded Problem Focused

99203 - LEVEL 3 New Patient, Office or other Outpatient Visit, Detailed

99204 - LEVEL 4 New Patient, Office or other Outpatient Visit, Comprehensive

99205 - LEVEL 5 New Patient, Office or other Outpatient Visit, Complex

99341 - LEVEL 1 New Patient, Home Visit, Problem Focused

99342 - LEVEL 2 New Patient, Home Visit, Expended Problem Focused

99343 - LEVEL 3 New Patient, Home Visit, Detailed

99344 - LEVEL 4 New Patient, Home Visit, Comprehensive

99345 - LEVEL 5 New Patient, Home Visit, Complex - Not Reimbursed by medicaid for CDMs or CPMs