Wiki Precipitous Nurse Delivery

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melheffley

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I need some written documentation on if the MD can bill for a precipitous nurse delivery. We have trouble with our hospital not calling the MD in time for the delivery and the nurse delivers. Nurse delivers patient, clamps & cuts cord and baby is in warmer prior to MD arrival to the room. We have been told before that if the the cord is still intact and MD cuts, he can claim the delivery, otherwise it is lost and cannot be billed. Hospital states that it doesn't matter and is billable. Everything I find seems to be very grey and how you want to interpret what a "delivery" is.

I saw a couple posts with a link to another website, but they were from 2010 and the link is no longer good. Does anyone have any idea where we can find a black and white answer? (when patient is in the hospital, MD is called, but baby delivers with RN prior to MD arrival from office)
 
I believe I have a document from ACOG on my work computer. If you message me your email, I can send it to you.
 
Interesting. If the OB did not deliver the kid, and a hospital-employed nurse did...... the MD can still bill his professional services for the delivery? I would argue that they could bill for the prenatal care without the delivery, but I would love to see the ACOG's rationale, since these professional organizations are not regulatory guidance and this has all of the hallmarks of fraudulent billing.
 
Pam Warren said:
Interesting. If the OB did not deliver the kid, and a hospital-employed nurse did...... the MD can still bill his professional services for the delivery? I would argue that they could bill for the prenatal care without the delivery, but I would love to see the ACOG's rationale, since these professional organizations are not regulatory guidance and this has all of the hallmarks of fraudulent billing.
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The physician can only bill a reduced service in this instance, not the full care. At least when I was working for ACOG this was always our response.
 
This is what they had said on the subject:

"Generally, when the physician has performed all the components of the global package but misses the delivery, the global package may be reported—that is, if the patient arrived at the hospital while the physician was in route and the nurse ended up performing the delivery but the physician arrived in time to deliver the placenta.

On the other hand, if the physician misses the delivery of the baby and the placenta, but arrives in time to take over from there, then it may be appropriate to bill the global code with a modifier 52 attached (i.e., 59400 -52 for a vaginal delivery). The 52 modifier indicates reduced services, since the physician did not perform the delivery. As such, the physician should consider lowering the fee to reflect the reduction in service. This reporting option should not be selected if anyone else is reporting for the delivery."
 
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