Wiki Solo Nurse Practitioner Obstetric Billing

[OrtizB17]

Hello,
I have an OB/GYN nurse practitioner who will be starting her own stand-alone clinic. She has a contract with the hospital, so they will be handling the deliveries. How do we bill for the obstetric care and antepartum she will be providing?

 

[nielynco]

Hello,
I have an OB/GYN nurse practitioner who will be starting her own stand-alone clinic. She has a contract with the hospital, so they will be handling the deliveries. How do we bill for the obstetric care and antepartum she will be providing?

If she is not doing the delivery, you bill according to CPT guidelines for the actual care rendered. This means you will not be billing globally but rather billing for antepartum care and postpartum care separately. Unless the payer dictates a specific billing method, if the patient only had 1, 2 or 3 visits prior to termination of antepartum care, you bill each using an E/M service. If the patient goes beyond three visits with the midwife and has a total of 4-6 antepartum visits, you code 59425 instead. If the patient goes beyond 6 total visits you now code 59426 instead. When postpartum care is provided you bill 59430 for any outpatient services related to the delivery. If the midwife provides any inpatient visits following the delivery performed by someone else, those can be billed separately using inpatient codes so long as the delivering provider has billed a "delivery only" code and not one that includes postpartum care.