Wiki C/S assist by midlevel with Fidelis

[Jeannie171717]

Fidelis Ins. wants us to bill out our C/S's totally different from CPT guidelines and other insurers when we have one of our own midwives assisting. They want us to use 59514 with an AS modifier, 59426 for the prenatal visits, and 59530 for the ppar exam. This is our patient and she has had all prenatal care through us. They don't think we should use the 59510 (global) at all. When we add up their allowances for billing this way it is $200.00 less than if we were to bill it as we normally would. That would be 59510 for the surgeon (global), 59514-AS for the assist and no charge for the ppar exam. Does anybody have any insight on this? Fidelis is refusing to budge! Thanks.

 

[Leandra]

If you are billing for a CNM assist with a c-section then we only bill 59514-81; we bill the global code under the physician who delivered (assuming all prenatal was done at our office).

However, there are some payers that do not want the global codes - they want each component billed separately. In that case I would bill:

59426 or 59425 (prenatal care)
59514 (physician delivery)
59514-81 for the assist only
59430 (postpartum) when pt has it done

Does that make sense? I'm not sure about the AS modifier - we don't use that.