Most midwives know about the basics when it comes to billing health insurance plans. If you work for a large practice, many providers don’t do anything with billing and have a whole department handle that aspect of care. When you start a private midwife practice (whether small or large), it is essential to know what the billing guidelines and coding system are like.
Revenue, particularly from insurance companies, is the bread and butter for most midwife businesses. Some choose to do cash, but that is getting harder and harder to keep a midwife business going when healthcare costs are soaring. Families depend on their insurance plans to cover midwifery services. What I am focusing on today isn’t typical maternity care and office codes. I am discussing commonly missed revenue codes that create additional cash flow to the business for care already being done.
The guidelines for maternity coding are based on hospital obstetrical care (office visits, delivery in the hospital, the nurse providing most of the labor support, and the doctor coming in to catch the baby at the end, etc.). Use high-quality care and all the extra things midwives do in community-based settings to your advantage when billing insurance companies. Home visits during maternity and postpartum care are outside of typical maternity care billing codes. The codes are based on complexity and time spent with patients.
The first visit with a nurse is billable as a nurse visit for time utilized. If a patient sees a midwife for a visit, confirmation of pregnancy with a urine pregnancy test is separate from routine prenatal care. Use new or established office visits, depending on the complexity and time spent with the patient. Urine pregnancy tests, lab draws, finger sticks for blood samples, wet mounts, and other office procedures are separate billable codes during pregnancy.
If a woman schedules an office visit outside of routine pregnancy or comes in for a prenatal visit with additional primary concerns (not discomforts of pregnancy) like flu, depression, or ear infection, it is a separate office visit charge.
Don’t forget about education and prevention.
Affordable care covers 100% of preventable services. Childbirth education, breastfeeding support, and tobacco counseling are common in pregnancy visits and need to be documented in the chart in order for billing codes to be reimbursed. Always put time spent with the patient on your summary notes. Midwives are great at spending lots of time with patients, and additional revenue is lost by not putting it in your notes. Your notes have many purposes: communication with staff of care recommendations, liability protection, and billing audits.
Most hospital-based midwives don’t do baby care during the first month of life, even though it is part of our training and scope. That is where community-based midwives shine with full family care. Newborn care is usually covered 100% by an insurance plan if billed as such. If a home visit code is used for care, it may be a deductible or co-payment aspect of insurance reimbursement. There are specific codes for newborn care that some insurance plans will pay for in a home setting versus an office.
Remember, a doctor and traditional hospital-based practices spend limited time at the bedside during birth. Homebirth and birth center midwives can use prolonged labor codes if they spend more than two hours continuously with women during labor. Some insurance plans do require this code to be used if a medical emergency is occurring, like postpartum hemorrhage or newborn resuscitation (others don’t). Birth assistants (whether another midwife or assistant), birth supplies, water use during labor and birth, medications like Rhogam, pitocin, cytotect, and iv fluids, are sometimes covered. Aetna and United Health Care typically cover more of these midwifery community-based codes.
Below is an extensive list of billing codes and their descriptions used for midwifery care. Please use as many codes as possible for the care you are providing. Midwives are valuable assets to health care, and all the quality, personalized care we provide needs to be counted for. Billing and coding are not part of midwifery education, but running a successful practice requires these skills to be known.
We developed the course, Comprehensive Billing and Coding for Birth Centers and Midwives, to help you understand the crucial elements that enable your practice.