Parents
Welcome
Sources
Claim Processing
Calling Insurance
Glossary
Midwives
What We Offer
Our Clients
Your Clients
Form Library
Resources | FAQs
About | Contact
Parents
Welcome
Sources
Claim Processing
Calling Insurance
Glossary
Midwives
What We Offer
Our Clients
Your Clients
Form Library
Resources | FAQs
About | Contact
NEWBORN FOLLOW-UP FORM
Select at least one diagnosis that applies to procedure/service
Midwife Code
If you've forgotten your unique midwife code,
contact us
Client Name
First Name
Last Name
Newborn Name
First Name
Last Name
Record details about each Newborn Follow-up Chronologically
1
Date
MM
DD
YYYY
Location
Office
Home
Hospital
Procedure
––– NB VISITS –––
99344 Initial Newborn Exam
99464 Birth Assistant
99465 Newborn Resuscitation
E0443 + E0425 O2 + Ambu Bag
84597 + 96372 Vitamin K
36415 NB Venip (cord blood)
36416 NB Venip - Heel, Finger
99349 Follow up NB Exam
94761 CCHD - Cardiac Oxim
84030 + 36416 + S3620 Newborn Infant Screen
99460 Initial Hospital - well baby day 1/1+ days
99462 Follow up Hospital Care - well baby
82948 Glucose
86900 Blood Typing ABO
86901 Blood Typing Rh (D)
S9098 Bililights at Home
41010 Frenulotomy
(COMB) NB Infant Screen
Was this procedure performed at delivery?
Yes
Diagnostic Code 1
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 2
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 3
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 4
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Continue or
Scroll to Submit.
2
Date
MM
DD
YYYY
Location
Office
Home
Hospital
Procedure
––– NB VISITS –––
99344 Initial Newborn Exam
99464 Birth Assistant
99465 Newborn Resuscitation
E0443 + E0425 O2 + Ambu Bag
84597 + 96372 Vitamin K
36415 NB Venip (cord blood)
36416 NB Venip - Heel, Finger
99349 Follow up NB Exam
94761 CCHD - Cardiac Oxim
84030 + 36416 + S3620 Newborn Infant Screen
99460 Initial Hospital - well baby day 1/1+ days
99462 Follow up Hospital Care - well baby
82948 Glucose
86900 Blood Typing ABO
86901 Blood Typing Rh (D)
S9098 Bililights at Home
41010 Frenulotomy
(COMB) NB Infant Screen
Was this procedure performed at delivery?
Yes
Diagnostic Code 1
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 2
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 3
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 4
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Continue or
Scroll to Submit.
3
Date
MM
DD
YYYY
Location
Office
Home
Hospital
Procedure
––– NB VISITS –––
99344 Initial Newborn Exam
99464 Birth Assistant
99465 Newborn Resuscitation
E0443 + E0425 O2 + Ambu Bag
84597 + 96372 Vitamin K
36415 NB Venip (cord blood)
36416 NB Venip - Heel, Finger
99349 Follow up NB Exam
94761 CCHD - Cardiac Oxim
84030 + 36416 + S3620 Newborn Infant Screen
99460 Initial Hospital - well baby day 1/1+ days
99462 Follow up Hospital Care - well baby
82948 Glucose
86900 Blood Typing ABO
86901 Blood Typing Rh (D)
S9098 Bililights at Home
41010 Frenulotomy
(COMB) NB Infant Screen
Was this procedure performed at delivery?
Yes
Diagnostic Code 1
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 2
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 3
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 4
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Continue or
Scroll to Submit.
4
Date
MM
DD
YYYY
Location
Office
Home
Hospital
Procedure
––– NB VISITS –––
99344 Initial Newborn Exam
99464 Birth Assistant
99465 Newborn Resuscitation
E0443 + E0425 O2 + Ambu Bag
84597 + 96372 Vitamin K
36415 NB Venip (cord blood)
36416 NB Venip - Heel, Finger
99349 Follow up NB Exam
94761 CCHD - Cardiac Oxim
84030 + 36416 + S3620 Newborn Infant Screen
99460 Initial Hospital - well baby day 1/1+ days
99462 Follow up Hospital Care - well baby
82948 Glucose
86900 Blood Typing ABO
86901 Blood Typing Rh (D)
S9098 Bililights at Home
41010 Frenulotomy
(COMB) NB Infant Screen
Was this procedure performed at delivery?
Yes
Diagnostic Code 1
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 2
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 3
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 4
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Continue or
Scroll to Submit.
5
Date
MM
DD
YYYY
Location
Office
Home
Hospital
Procedure
––– NB VISITS –––
99344 Initial Newborn Exam
99464 Birth Assistant
99465 Newborn Resuscitation
E0443 + E0425 O2 + Ambu Bag
84597 + 96372 Vitamin K
36415 NB Venip (cord blood)
36416 NB Venip - Heel, Finger
99349 Follow up NB Exam
94761 CCHD - Cardiac Oxim
84030 + 36416 + S3620 Newborn Infant Screen
99460 Initial Hospital - well baby day 1/1+ days
99462 Follow up Hospital Care - well baby
82948 Glucose
86900 Blood Typing ABO
86901 Blood Typing Rh (D)
S9098 Bililights at Home
41010 Frenulotomy
(COMB) NB Infant Screen
Was this procedure performed at delivery?
Yes
Diagnostic Code 1
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 2
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 3
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 4
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Continue or
Scroll to Submit.
6
Date
MM
DD
YYYY
Location
Office
Home
Hospital
Procedure
––– NB VISITS –––
99344 Initial Newborn Exam
99464 Birth Assistant
99465 Newborn Resuscitation
E0443 + E0425 O2 + Ambu Bag
84597 + 96372 Vitamin K
36415 NB Venip (cord blood)
36416 NB Venip - Heel, Finger
99349 Follow up NB Exam
94761 CCHD - Cardiac Oxim
84030 + 36416 + S3620 Newborn Infant Screen
99460 Initial Hospital - well baby day 1/1+ days
99462 Follow up Hospital Care - well baby
82948 Glucose
86900 Blood Typing ABO
86901 Blood Typing Rh (D)
S9098 Bililights at Home
41010 Frenulotomy
(COMB) NB Infant Screen
Was this procedure performed at delivery?
Yes
Diagnostic Code 1
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 2
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 3
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 4
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Continue or
Scroll to Submit.
7
Date
MM
DD
YYYY
Location
Office
Home
Hospital
Procedure
––– NB VISITS –––
99344 Initial Newborn Exam
99464 Birth Assistant
99465 Newborn Resuscitation
E0443 + E0425 O2 + Ambu Bag
84597 + 96372 Vitamin K
36415 NB Venip (cord blood)
36416 NB Venip - Heel, Finger
99349 Follow up NB Exam
94761 CCHD - Cardiac Oxim
84030 + 36416 + S3620 Newborn Infant Screen
99460 Initial Hospital - well baby day 1/1+ days
99462 Follow up Hospital Care - well baby
82948 Glucose
86900 Blood Typing ABO
86901 Blood Typing Rh (D)
S9098 Bililights at Home
41010 Frenulotomy
(COMB) NB Infant Screen
Was this procedure performed at delivery?
Yes
Diagnostic Code 1
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 2
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 3
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 4
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Continue or
Scroll to Submit.
8
Date
MM
DD
YYYY
Location
Office
Home
Hospital
Procedure
––– NB VISITS –––
99344 Initial Newborn Exam
99464 Birth Assistant
99465 Newborn Resuscitation
E0443 + E0425 O2 + Ambu Bag
84597 + 96372 Vitamin K
36415 NB Venip (cord blood)
36416 NB Venip - Heel, Finger
99349 Follow up NB Exam
94761 CCHD - Cardiac Oxim
84030 + 36416 + S3620 Newborn Infant Screen
99460 Initial Hospital - well baby day 1/1+ days
99462 Follow up Hospital Care - well baby
82948 Glucose
86900 Blood Typing ABO
86901 Blood Typing Rh (D)
S9098 Bililights at Home
41010 Frenulotomy
(COMB) NB Infant Screen
Was this procedure performed at delivery?
Yes
Diagnostic Code 1
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 2
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 3
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 4
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Continue or
Scroll to Submit.
9
Date
MM
DD
YYYY
Location
Office
Home
Hospital
Procedure
––– NB VISITS –––
99344 Initial Newborn Exam
99464 Birth Assistant
99465 Newborn Resuscitation
E0443 + E0425 O2 + Ambu Bag
84597 + 96372 Vitamin K
36415 NB Venip (cord blood)
36416 NB Venip - Heel, Finger
99349 Follow up NB Exam
94761 CCHD - Cardiac Oxim
84030 + 36416 + S3620 Newborn Infant Screen
99460 Initial Hospital - well baby day 1/1+ days
99462 Follow up Hospital Care - well baby
82948 Glucose
86900 Blood Typing ABO
86901 Blood Typing Rh (D)
S9098 Bililights at Home
41010 Frenulotomy
(COMB) NB Infant Screen
Was this procedure performed at delivery?
Yes
Diagnostic Code 1
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 2
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 3
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 4
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Continue or
Scroll to Submit.
10
Date
MM
DD
YYYY
Location
Office
Home
Hospital
Procedure
––– NB VISITS –––
99344 Initial Newborn Exam
99464 Birth Assistant
99465 Newborn Resuscitation
E0443 + E0425 O2 + Ambu Bag
84597 + 96372 Vitamin K
36415 NB Venip (cord blood)
36416 NB Venip - Heel, Finger
99349 Follow up NB Exam
94761 CCHD - Cardiac Oxim
84030 + 36416 + S3620 Newborn Infant Screen
99460 Initial Hospital - well baby day 1/1+ days
99462 Follow up Hospital Care - well baby
82948 Glucose
86900 Blood Typing ABO
86901 Blood Typing Rh (D)
S9098 Bililights at Home
41010 Frenulotomy
(COMB) NB Infant Screen
Was this procedure performed at delivery?
Yes
Diagnostic Code 1
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 2
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 3
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 4
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Continue or
Scroll to Submit.
11
Date
MM
DD
YYYY
Location
Office
Home
Hospital
Procedure
––– NB VISITS –––
99344 Initial Newborn Exam
99464 Birth Assistant
99465 Newborn Resuscitation
E0443 + E0425 O2 + Ambu Bag
84597 + 96372 Vitamin K
36415 NB Venip (cord blood)
36416 NB Venip - Heel, Finger
99349 Follow up NB Exam
94761 CCHD - Cardiac Oxim
84030 + 36416 + S3620 Newborn Infant Screen
99460 Initial Hospital - well baby day 1/1+ days
99462 Follow up Hospital Care - well baby
82948 Glucose
86900 Blood Typing ABO
86901 Blood Typing Rh (D)
S9098 Bililights at Home
41010 Frenulotomy
(COMB) NB Infant Screen
Was this procedure performed at delivery?
Yes
Diagnostic Code 1
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 2
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 3
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 4
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Continue or
Scroll to Submit.
12
Date
MM
DD
YYYY
Location
Office
Home
Hospital
Procedure
––– NB VISITS –––
99344 Initial Newborn Exam
99464 Birth Assistant
99465 Newborn Resuscitation
E0443 + E0425 O2 + Ambu Bag
84597 + 96372 Vitamin K
36415 NB Venip (cord blood)
36416 NB Venip - Heel, Finger
99349 Follow up NB Exam
94761 CCHD - Cardiac Oxim
84030 + 36416 + S3620 Newborn Infant Screen
99460 Initial Hospital - well baby day 1/1+ days
99462 Follow up Hospital Care - well baby
82948 Glucose
86900 Blood Typing ABO
86901 Blood Typing Rh (D)
S9098 Bililights at Home
41010 Frenulotomy
(COMB) NB Infant Screen
Was this procedure performed at delivery?
Yes
Diagnostic Code 1
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 2
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 3
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Diagnostic Code 4
V20.2 Routine Infant or Child Health Check
V21.30 Unspec Low Birth Weight
V29.2 Observe/Suspect Respiratory
V29.9 Observe for Unspec Suspect Condition
V30.2 Single NB Born Outside Hospital
V31.2 Twins Born at Home
V77.3 Metabolic Screening
750.O Tongue Tie
750.26 Other Mouth Anomalies, Frenulum
763.O Breech Delivery Affecting Newborn
763.1 Other Malposition Affecting Newborn
763.6 Precip Delivery Affecting Newborn
764.OO Small for Gest Age
767.2 Fractured Clavicle
769 Resp Distress Syndrome
770.1 NB Aspiration Unspec
770.6 Transitory Tachypnea
770.81 Primary Apnea
771.7 Thrush
772.3 Umbilical Bleeding
774.6 Jaundice
779.31 Feeding Problems
779.34 Failure to Thrive
783.21 Weight Loss
783.4O Slow Weight Gainer
796.1 Poor (Sucking) Reflex
V72.86 Blood typing
Last
END
Enter any additional comments before submitting your form to Clearbill
Additional Comments
Thank you for your form submission
