Ob-Gyn Coding Alert

Question: Our Certified Nurse Midwife is seeing GYN patients for routine exams. During the exam the midwife discovers a complicated problem and turns the patient over to one of our physicians for further evaluation and treatment. How can I bill for this if the patient is seen by both the midwife and the physician on the same day?

Dianne Wilson, CMM, Practice Administrator
Birth and Womens Care, PA, Fayetteville, NC

Answer: If both the CNM and physician are billing under the same provider number you cannot bill for both services at the same encounter. You would bill the highest level of service provided by the physician at that encounter. This will probably include a review of the exam conducted by the nurse midwife so you can get credit for that work. If there are two different billing numbers you might be able to convince a third-party payer that two distinct E/M services were performed on the same day. It would be doubtful in the scenario described above (i.e. the patient is turned over to the physician to evaluate and treat) that the physician portion qualifies as a consultation. A consultation requires that there be a request in writing and that a written report be sent back to the requesting caregiver. The consultation is for an opinion or advice, not to evaluate and treat.