Wiki Resources or advice needed ... Midwife services

[debellis59]

HI Everyone:

I code for an OBGYN practice in Oregon. Last year we took on a midwife practice and they are looking at expanding their services. Although I've been doing OBGYN for over 20 years, I'm at a loss on this.

We currently have two MDs and seven midwives. The midwives will be taking on newborn services (hospital and first WCC in the office) and I'm good with how to do all that having done pediatrics for many years in my past. BUT, they are also wanting to take on lactation services. It's my understanding in Oregon they can do this, but can they bill for lactation services and it be outside the Delivery global? I know they could do it for the other OBGYNs that deliver at our hospital, but not so sure about for themselves and the OBGYN MDs in our practice. I am having no luck finding anything definitive.

They also have discussed dyad services so billing for both baby and mom with lactation issues ... dividing the time while observing both baby and Mom.

Can anyone give me direction or advice? I know all states are a bit different, but I'm thinking some of these (lactation) services may not be billable unless done for providers outside our practice.

I appreciate any help anyone can provide.

Thank you so much in advance

 

[TThivierge]

Hello Debellis59
Midwives if licensed or certified be considered QHP which is considered for coverage on some treatments in the CPT manual. A credentialied MD must be the referral source on the claim. Also as long as one of the MD referred the patient there for this service for neonate nutrition or wellness guides regarding Mom self care but check with the payer. Modifier will be SB. Use the following CPTs for QHP staff such as: CPT 99211, CPT 99412 preventive care, counseling assessments CPT 96156-96168, Online care for est. patients could be used with Zoom (use modifier 95)or phone calls for QHP staff CPT 98966 -98968. Remote monthly check or follow up for QHP are G0108 G0109 G0420-G0421 G0296 . CPT 99457 -99458 remote only used once a month. Online check CPT 99421 for est pt. Digital msg CPT 98971 98972
Ensure pt has approved for video or online or phone call then verify pt demographics on top of medical record. QHP should list or describe discussion or plan of care referral from doctor's name and assessment /dx codes. Also for each CPT used add time spoke /treated pt. all used for established pts.
Well I hope helped you a little bit for services can use for midwives.
Lady T

 

[debellis59]

Hello Debellis59
Midwives if licensed or certified be considered QHP which is considered for coverage on some treatments in the CPT manual. A credentialied MD must be the referral source on the claim. Also as long as one of the MD referred the patient there for this service for neonate nutrition or wellness guides regarding Mom self care but check with the payer. Modifier will be SB. Use the following CPTs for QHP staff such as: CPT 99211, CPT 99412 preventive care, counseling assessments CPT 96156-96168, Online care for est. patients could be used with Zoom (use modifier 95)or phone calls for QHP staff CPT 98966 -98968. Remote monthly check or follow up for QHP are G0108 G0109 G0420-G0421 G0296 . CPT 99457 -99458 remote only used once a month. Online check CPT 99421 for est pt. Digital msg CPT 98971 98972
Ensure pt has approved for video or online or phone call then verify pt demographics on top of medical record. QHP should list or describe discussion or plan of care referral from doctor's name and assessment /dx codes. Also for each CPT used add time spoke /treated pt. all used for established pts.
Well I hope helped you a little bit for services can use for midwives.
Lady T

It's a lot to digest. And on top of needing to learn this and prepare education for my providers, we're "partnering" with another hospital/clinic entity and going on their system as of this Sunday ... So all a bit overwhelming ... plus a second job and studying for my CPMA. Okay, a lot overwhelming. When it rains, it pours.

I really appreciate you help so much. Thank you for your response!