Newborn Diagnosis And TOB

Quest ion:

We have twins who were born at another facility and tansferred to our facility. The insurance company is stating that we need to bill with a diagnosis in the rane of Z38 00 - Z38 8 However, CMSguidelines state that a code from category Z38 is only assigned at the time of birth.

If a newborn is transferred to another institution, a code from category Z38 should not be used at the receiving hospital We have tried appealing the claims with records and the coding guidelines to show we were the receiving hospital for these twins But the appeal was denied, still stating that there is a conflict with the type of bill and/or diagnosis code. What can you recommend?

Answ er:

When a newborn is transferred from another hospital immediately following birth, the correct Admission Type to be reported by the receiving hospital on a UB claim is "1" (Emergency)

The Special Point of Origin Code (FL 15) of "6" appropriately indicates that the infant was admitted as a transfer from another healthcare facility for specialized or higher-level care related to the childbirth process

Newborn Diagnosisand Tob

As you pointed out, the ICD-10 Official Coding Guidelines, Chapter 16 ,Z38 codes may not be reported by Onslow as the receiving hospital of the transferred infants.