CPT Code 99465 – Delivery/birthing Room Resuscitation

CPT code 99465 is used for billing the procedure performed on newborns in the delivery room. The American Medical Association (AMA) maintained two codes for billing delivery-related procedures for newborns. These newborn CPT codes include 99464 and 99465 under the “Delivery/Birthing Room Attendance and Resuscitation Services category.”

The medical coding method uses multiple codes to determine the newborn’s health status soon after birth. These codes depend on various factors, such as the baby’s health, the location where the service was performed, etc. It is essential to stay current and adhere to neonatal coding guidelines to ensure accurate medical billing and coding.

Today’s post is all about CPT code 99465. Various aspects related to the newborn CPT codes, including 99464 and 99465, are highlighted in this post. So, read on to familiarize yourself with these codes performed in the delivery or birthing room.

CPT Code 99465

The CPT code 99465 is billed to get the payment if the other physician was present during delivery and performed resuscitation. Billing CPT code 99465 requires proper documentation to demonstrate whether or not the infant was in distress.

CPT 99465 Description

The code description for CPT 99465 is Delivery/birthing room resuscitation, provision of positive pressure ventilation, and chest compressions in the presence of acute inadequate ventilation and cardiac output.

Resuscitation of the newborn is the procedure of providing:

• Ventilation or breathing
• Chest compression

The services rendered as part of the Attendance at delivery (CPT 99464) code include the following:

• Obtaining fetal and maternal histories
• Examining labor records and mother’s charts
• Providing the care needed for the newborn’s health

Attendance at delivery does not consist of endotracheal intubation (31500). In case newborn resuscitation is performed, then 99464 is not billed. Instead, the CPT code 99465 is billed for the procedure of newborn resuscitation.

Newborn CPT Codes

In the Current Procedural Terminology (CPT) system, being present at the birth of a baby and being present at the birth of a baby requiring resuscitation each has unique codes.

CPT 99464 represents being present for the birth (where requested by the delivering physician) and ensuring the newborn’s immediate stability.

CPT 99465 represents resuscitation in the delivery room, involving chest compressions or ventilation in the case of acute inadequate ventilation or cardiac output.

Both codes are similar; however, CPT 99464 cannot be billed alongside 99465. The primary distinction between these two newborn CPT codes is whether resuscitation was attempted.

The primary distinction between the two codes is whether the patient has been stabilized or revived. Attendance at delivery (99464) includes the use of blow-by oxygen or continuous positive airway pressure (CPAP) if positive-pressure ventilation (PPV) is unavailable.

One of the most notable differences between CPAP and PPV is the timing of therapy administration.

PPV should be utilized if the infant’s heart rate is below 100 beats per minute and is fighting to breathe or has apnea. It involves using a mask, an inflating bag, or a resuscitator with a T-piece to provide air to the newborn. This procedure allows the lungs to exchange more air with the outside air.

Newborns with a heart rate of more than 100 beats per minute, difficulty breathing, or cyanosis can be treated with supplemental oxygen and CPAP. CPAP therapy should be utilized if any of the following conditions exist:

• Respiratory distress syndrome
• Atelectasis
• Respiratory acidosis
• Apnea of prematurity

Even if the other physician arrives a few seconds or minutes later than anticipated, the CPT code 99464 should not be utilized, per AAPC regulations. In this instance, a code for critical or neonatal care that is more accurate or specific must be utilized. For CPT code 99464 to be applicable, the accompanying physician must be in the operating room at the delivery time. The CPT code 99464 should only be billed if the physician who delivered the infant specifically requested a pediatrician. This is one of the most crucial things to know. In addition, the paperwork must indicate that the OB requested the page so that the pediatrician may be present in the surgery room.

For the use of an AAD, there must be a medical need that is backed by evidence. If the practice or provider requires pediatricians to be in the operating room during deliveries or C-sections, their presence is not a medical requirement. The infant must be distressed and stabilized immediately after birth to qualify for CPT 99464.

The following are included in the stabilization of the newborn:

• Stimulation
• Initial drying
• Apgar (Appearance, Pulse, Grimace, Activity, and Respiration)
• Suctioning
• Visual inspection
• Blow up
• CPAP
• Discussion with OB and parents

Billing CPT Code 99465

CPT 99465 is for resuscitation, and for billing this code, either one of the below two procedures must be performed:

• Positive pressure ventilation (PPV)
• Cardiopulmonary Resuscitation (CPR)

Resuscitation is the act of combining the following:

• CPR
• Mask and bag usage
• Ventilation and intubation

For billing of CPT code 99465, the newborn must be in distress, which must be evidenced through documentation. Any of the following is used for the documentation purpose depending on the medical condition of the newborn:

• Acute inadequate cardiac output or ventilation
• Acute respiratory failure or distress
• Any other cardiopulmonary distress

The CPT code 99465 may only be billed to get the payment if the other physician was present during delivery and performed resuscitation. Effective billing of this CPT code requires proper documentation to demonstrate whether or not the newborn was in distress. It is important to remember that resuscitation and AAD (attendance at delivery) are different services that cannot be billed on the same day.

See Also: All You Want to Know About custom CPT codes for Orthotics.

Conclusion

The Current Procedural Terminology (CPT) system has various codes for newborns, including 99464 and 99465. CPT 99464 requires attending the birth when requested by the doctor in charge of the delivery and guaranteeing the baby’s immediate stability. CPT code 99465 is for resuscitation. In the labor room, resuscitation comprises chest compressions or ventilation in the event of a sudden loss of breathing or heart activity. Despite their similarity, you cannot simultaneously bill for CPT codes 99464 and 99465. The primary difference between these two neonatal CPT codes is whether or not resuscitation was attempted. So, these two codes cannot be billed on the same day.

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