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fabiang

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I work at a FQHC organization and we have a CNM who spends prolonged hours with a patient. She is in attendance at all times, but does not deliver, only monitoring. My question is as an FQHC, are we allowed to charge for prolonged services because she does not get reimbursement for the delivery? Or does everything fall under global? Thank you
 
First, CPT for prolonged physician services can not be used alone. Prolonged services are add on codes. Providing physician must go over the original service's expected time by at least 30 minutes, again you can only use prolonged service codes with a CPT code that has time as part of its definition.
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You could not use prolonged services codes if you report surgery or global maternity care or a delivery. You can, however, use these codes when you report an E/M service.
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In the OB situation in which the CNM manages the labor and the ob-gyn ends up doing a cesarean, the CNM may bill for her time by coding a hospital admission and subsequent care up to the point that the physician took over, because the CNM cannot bill for the global care for cesarean delivery. In this case you need to make sure CNM was admitting provider and not the physician. If the CNM is the admitting, once you determine the level of E/M service, the CNM may also bill for prolonged inpatient service if the total time with the patient adds up to 30 minutes more than the typical time listed in the hospital care code.*
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For example, if the CNM reported 99222 for the hospital admission, she must spend at least 80 minutes with the patient face to face before reporting the prolonged service code as well. Her claim must include the normal documentation that carriers require for the inpatient admission code, plus a description of services that required her constant attention, plus the documented time with the patient.
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For Vaginal delivers which CNM are allowed to do, carriers might not reimburse prolonged services when labor progresses normally. The ob-gyn would step in when the baby gets stuck (perhaps needing vacuum extraction by the ob-gyn). In that case, and if the CNM does most of the delivery, you would not be able to report an E/M service for the labor management.
 
tblmt1966 said:
First, CPT for prolonged physician services can not be used alone. Prolonged services are add on codes. Providing physician must go over the original service's expected time by at least 30 minutes, again you can only use prolonged service codes with a CPT code that has time as part of its definition.
*
You could not use prolonged services codes if you report surgery or global maternity care or a delivery. You can, however, use these codes when you report an E/M service.
**
In the OB situation in which the CNM manages the labor and the ob-gyn ends up doing a cesarean, the CNM may bill for her time by coding a hospital admission and subsequent care up to the point that the physician took over, because the CNM cannot bill for the global care for cesarean delivery. In this case you need to make sure CNM was admitting provider and not the physician. If the CNM is the admitting, once you determine the level of E/M service, the CNM may also bill for prolonged inpatient service if the total time with the patient adds up to 30 minutes more than the typical time listed in the hospital care code.*
*
For example, if the CNM reported 99222 for the hospital admission, she must spend at least 80 minutes with the patient face to face before reporting the prolonged service code as well. Her claim must include the normal documentation that carriers require for the inpatient admission code, plus a description of services that required her constant attention, plus the documented time with the patient.
*
For Vaginal delivers which CNM are allowed to do, carriers might not reimburse prolonged services when labor progresses normally. The ob-gyn would step in when the baby gets stuck (perhaps needing vacuum extraction by the ob-gyn). In that case, and if the CNM does most of the delivery, you would not be able to report an E/M service for the labor management.
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I found out what specific service she wants to bill for. She wants to bill for doula work/labor support service. As an FQHC, can we bill for that? She did not deliver, only in attendance. Please help. Thank you.
 
No, not that I am aware of. What state are you in as I stated before each state has different guidelines. I am going to certification course for FQHC next month. I will be more then happy to ask thou. If you have any others question before September 5 I will be more then happy ask for you.
 
Prolonged Services without Direct Patient Care

We have situations whereby the Doctor is conducting a phone call to a patient who is out of state, and at that time the Doctor is reviewing patient Medical History and testing in order for the patient to be set up for a face to face consultation in the near future.

He typically spends 45-60 minutes reviewing and discussing these results and findings with the patient during that phone encounter.

The patient now comes in for their Initial face to face Office visit with the doctor, how would you code this?

Does the Prolonged Service w/out Direct Patient Care apply in this situation?
 
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