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MP 10.01.04

Physician Attendance at Delivery for Newborn Care


Medical Policy
Section
Administrative
Original Policy Date
11/30/96
Last Review Status/Date
Reviewed by consensus/4:2003
Issue
4:2003
Return to Medical Policy Index

Disclaimer

Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract.  Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage.  Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.


Description

A qualified physician (specifically, a pediatrician or a neonatologist) is physically present in the delivery room or operating room to receive an infant on delivery.


Policy

The services of an additional physician for the neonate at a cesarean section or vaginal delivery are considered medically necessary when requested by the attending physician and there is documentation of fetal distress or reasonable anticipation of newborn distress and the additional physician in attendance is directly involved in providing a service to the infant.


Policy Guidelines

The initial newborn examination is included as part of the service by the physician in attendance at delivery.

 

Services by the additional physician are routinely not covered if subsequent professional services are not rendered by the same physician. When subsequent professional services are rendered by the same physician, the attendance is not paid as a separate service; it is an integral part of subsequent services.


Benefit Application

BlueCard/National Account Issues

The information compiled for this policy was a combination of standard billing practices, Plan policies, and claims experience.


Rationale

No applicable information

 

Codes

Number

Description

CPT  99357  Prolonged physician service 
ICD-9 Procedure    Code applicable “delivery” codes 
ICD-9 Diagnosis  768.2–768.4  Fetal distress 
HCPCS  No code 
Type of Service  OB/GYN 
Place of Service  Inpatient 


Index

Attendance at delivery, physician
Cesarean section, physician at attendance
Delivery, physician at attendance
Physician attendance at delivery


Policy History

Date Action Reason
11/30/96 Add to Administrative section New policy
05/15/02 Replace policy Policy reviewed without literature review; new review date only
12/17/03 Replace policy Policy reviewed by consensus without literature review; no changes in policy; no further review scheduled.


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