Billing and coding for midwifery services
Billing and coding for midwifery services can be complex, and there are several charges that are commonly missed by midwives. Accurate billing and coding are essential for ensuring proper reimbursement and compliance with healthcare regulations.
Here are some charges that midwives should be mindful of to avoid common billing and coding errors:
Confirmation of Pregnancy Visit
Midwives often provide a comprehensive package of maternity care services, including prenatal care, childbirth attendance, and postpartum care. Many don’t realize their consultations to see if they are a good fit for their services, and confirming a client is pregnant isn’t part of global midwifery charges and a separate office visit (usually a level 5 new PT visit).
Ultrasounds and Diagnostic Test
If midwives order ultrasounds, genetic testing, or other diagnostic tests during pregnancy, they should use the appropriate codes for ordering and interpreting these tests.
Non-Stress Tests (NSTs)
If NSTs are conducted to monitor fetal well-being, they should be billed separately using the correct CPT codes.
Additional Services and Procedures
Midwives may perform various procedures during prenatal and postpartum care, such as cervical cultures, cervical sweeps, or episiotomy repairs. Ensure that these procedures are accurately documented and billed using the appropriate codes.
Midwives who offer home birth services should bill for home visits separately from clinic or office visits. You can use the appropriate place-of-service (POS) codes to indicate the location of the service.
If midwives provide lactation counseling or support services, ensure these services are billed using the appropriate CPT codes for lactation consultation.
With the increasing use of telehealth, midwives should use the correct telehealth-specific codes when conducting virtual visits or consultations.
Supplies and Equipment
Ensure that any supplies or equipment provided during prenatal or postpartum visits, such as birthing kits or breast pumps, are appropriately documented and billed.
When midwives spend extra time with patients during a visit due to complex medical or counseling needs, consider using prolonged service codes (e.g., CPT codes 99354 and 99355) to account for the additional time spent.
Consultations with Other Healthcare Providers
Midwives may consult with or refer patients to other healthcare providers, such as obstetricians or specialists. Ensure that these consultations are documented and billed appropriately.
Thorough and accurate documentation is critical for proper billing and coding. Ensure that all services provided are well documented, including the reason for the visit, assessments, interventions, and follow-up plans.
When necessary, use appropriate modifiers to provide additional information about the service or indicate specific circumstances, such as services provided by a certified nurse-midwife (CNM) or licensed midwife.
Verify patients’ insurance coverage and eligibility before providing services to ensure you are billing the correct payer.
Adhere to the timely filing deadlines of insurance companies to avoid claim denials due to late submissions.
Ensure your billing and coding staff are well-trained and up-to-date on current coding guidelines and regulations.
To avoid common billing and coding errors, midwives should stay informed about changes in healthcare coding and documentation requirements, seek guidance from professional organizations, and invest in comprehensive billing and coding training if necessary. Additionally, it’s essential to maintain accurate and detailed patient records to support the billing and coding processes.