Title: 
Headings: 
Newborn
 
Inpatient
 
Benefits
 
and
 
Criteria
 

Content: Complete
 
physical
 
exam
 
of
 
the
 
newborn,
 
including
 
vital
 
signs,
 
observation
 
of
 
skin,
 
head,
 
face,
 
eyes,
 
nose,
 
ears,
 
mouth,
 
neck,
 
vocalization,
 
thorax,
 
lungs,
 
heart
 
and
 
vascular
 
system,
 
abdomen,
 
genitalia,
 
extremities,
 
and
 
back. Newborns
 
admitted
 
to
 
accommodations
 
other
 
than
 
the
 
well-baby
 
nursery
 
must
 
be
 
eligible
 
for
 
Medicaid
 
benefits
 
in
 
their
 
own
 
right
 
(claim
 
must
 
be
 
billed
 
under
 
the
 
baby’s
 
own
 
name
 
and
 
Medicaid
 
number). Example: If
 
an
 
infant
 
is
 
admitted
 
to
 
an
 
intensive
 
care
 
or
 
other
 
specialty
 
care
 
nursery,
 
the
 
claim
 
must
 
be
 
billed
 
under
 
the
 
infant’s
 
number
 
even
 
if
 
the
 
mother
 
is
 
still
 
an
 
inpatient. NOTE: When
 
billing
 
for
 
multiple
 
births,
 
list
 
each
 
baby’s
 
accommodation
 
separately,
 
noting
 
“Baby
 
A,”
 
“Baby
 
B,”
 
and
 
so
 
on. Also,
 
use
 
the
 
diagnosis
 
codes
 
that
 
indicate
 
multiple
 
live
 
births. For
 
multiple
 
births,
 
nursery
 
days
 
equals
 
the
 
sum
 
of
 
the
 
number
 
of
 
infants
 
times
 
the
 
number
 
of
 
the
 
mother's
 
days. Unless
 
the
 
newborn
 
infant
 
needs
 
medically
 
necessary,
 
specialized
 
care
 
as
 
defined
 
below,
 
no
 
additional
 
billings
 
for
 
inpatient
 
services
 
are
 
allowed
 
while
 
the
 
mother
 
is
 
an
 
inpatient. To
 
bill
 
Medicaid
 
utilizing
 
revenue
 
codes
 
172
 
(Nursery/Continuing
 
Care),
 
173
 
(Nursery/Intermediate
 
Care),
 
174
 
(Nursery
 
Intensive
 
Care),
 
and
 
179
 
(Nursery/Other),
 
the
 
infant
 
must
 
meet
 
the
 
following
 
criteria
 
established
 
by
 
Medicaid.