Billing and coding for Midwives
All midwives have to make a living, and most of us have to learn how to bill and code correctly in order to do this.
Billing and coding for midwifery services require as much training and consume as much time as providing those services, or so it sometimes seems. A helpful source is the ACNM’s handbook, “Getting Paid: Billing, Coding, and Payment for Midwifery Services,” which includes information on federal and state laws and regulations, Medicare and Medicaid, private third-party payers, fraud and abuse in billing, contracting with managed care organizations, coding, and more. You can order it from their website.
Remember that when you are completing a billing slip for insurance, you must always have six items of information: the patient’s name and identifying information (usually medical record number and birth date), which are frequently available on a plastic ID card which can be used to stamp the slip; your name and provider number; the date; the place of service; the CPT code, and the ICD code. Some billling entities may also require other information, such as an account number. If you are billing “incident to” another provider, that information must also be given.
Contrary to some information that I have heard, midwives do not use “different” ICD codes than physicians use. You can get a pocket-sized list of the most common codes used by midwives To maximize your chances of optimal reimbursement, you need to add modifiers where indicated, mostly for obstetric codes. The most common modifiers (or fifth digits, as they are also called) are “3,” signifying antepartum, and “4” signifying postpartum.
The pregnancy codes are those from 630 to 650; birth codes are from 650 (the code for normal uncomplicated birth) to 670. These codes almost always require the fifth digit. GYN codes are from 610 to 630. “V” codes are used for conditions that are not classified as a diagnosis per se, such as normal pregnancy (V22._), or normal pelvic exam (V72.3), which is the code to use for an annual pelvic exam when no pathology is found. Screening codes are also V codes; these are very useful when you need a code to order a lab test, but don’t have a diagnosis yet. Cholesterol screening, V77.9, is an example of these codes. My favorite code for ordering lab tests is 780.79, “fatigue.”
For documentation guidelines for evaluation and management (E/M) services, including definitions of everything (e.g., history of present illness, chief complaint), go to http://www.accuchecker.com/AccuLibrary/Articles/docevamanserv.asp. For a definition of hospital observation services and how to bill them (very useful to midwives who admit patients and then have to turn them over to the obstetric service or consultant for ongoing management), go to http://www.accuchecker.com/acculibrary/articles/e&mhospitalobservation.asp. These pages are part of a larger website, AccuChecker, an online medical coding and diagnosis subscription service which has a lot of useful information.
The Midwifery Business Network is a partner organization of the American College of Nurse-Midwives composed of CNMs/CMs from midwifery practices across the United States. The group meets semi-annually in the spring and fall to network, share information, and provide support to other members. Practices represented are both large and small, rural and urban, public and private. Learn more and join MBN at www.midwiferybusinessnetwork.com.
The following websites offer information or assistance to physicians and midwives seeking coding clarification:
- The Office of Inspector General; has new compliance guidelines for individual and small group practice providers; www.dhhs.gov/progorg/oig
- The Health Care Financing Administration’s Information Clearinghouse is an online source of HCFA publications and information; http:// www.cms.gov/pubforms/progman.htm
- EMPhysys offers links to other coding resources, including HCFA, OIG, and others; www.emphysys.com
- The American Academy of Professional Coders (AAPC) has extensive state-by-state chapter listings to help locate a local coding expert. (For phone numbers not listed, call AAPC at (800)626-2633; www.aapc.com