The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Unusual Insurance Billing Codes

There's an interesting site on the Web that discusses the issue of insurance coding of obstetric services for family physicians. Many of the same issues discussed here apply to homebirth midwives.

I don't know enough about this issue to know how many of these could really be used by homebirth midwives, but perhaps those who do could comment on these.

Here are some of the codes I found particular interesting:

Of Possible Interest to Second Midwives:

Newborn Care

Family physicians who provide maternity services are the only specialists who care for the mother, the family, and the newborn. There are several special newborn care codes available to family physicians:

99360 - Physician standby service, requiring prolonged physician attendance, each 30 minutes (e.g., operative standby, standby for frozen section, for cesarean/high risk delivery for newborn care, for monitoring EEG)

Family physician groups who utilize one family physician as the cesarean section assistant surgeon and/or surgeon, may call in a colleague to care for the baby. This pediatric standby service may be described by using the 99360 code for each 30 minutes. The CPT book says to use this code when the standby service "is requested by another physician and . . . involves prolonged physician attendance without direct (face-to-face) patient contact." In addition, "The physician may not be providing care or service to other patients during this time period. This code is not used to report time spent proctoring another physician."

Physicians should use code 99360 to report the total time spent on standby on a given date. The physician can only report standby service if a full 30 minutes, or more, of standby is provided. Standby services of less than 30 minutes cannot be reported separately. In addition, the physician can only report second and subsequent standby periods if a full 30 minutes of standby is provided for each unit of service reported.

99440 - Newborn resuscitation: Provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output

Deliveries can result in a newborn needing resuscitation. Even minimal resuscitation (following neonatal advance life support criteria), including suction, stimulation, oxygen therapy, nasogastric intubation, endotracheal examination, tracheal suction, etc., may qualify for code 99440.

Any anytime you're trying to get a labor going, you're probably checking heart tones.

Fetal Monitoring

59020 - Fetal contraction stress test

Many times, physicians will utilize electronic fetal monitoring to perform a fetal contraction test at the onset of induction or augmentation of labor. If the physician documents this service and provides it in the office or the hospital, with or without the provision of other evaluation and management codes, then the physician should use this code to describe that service in addition to any other services provided. It does not matter what technique the physician uses to induce the contractions (e.g., breast stimulation, oxytocin, etc.).

And when you check the woman in early labor:

59025 - Fetal non-stress test

Again, electronic fetal monitoring provides the option for family physicians to perform fetal non-stress tests before the onset of three or more contractions in a ten minute period. If the physician does this service in the office or the hospital and documents it, then the physician should use this code to describe this service in addition to any other services provided.

For labor coaching at home?

59050 - Fetal monitoring during labor by consulting physician (i.e., non-attending physician) with written report (separate procedure); supervision and interpretation

59051 - Fetal monitoring during labor by consulting physician (i.e., non-attending physician) with written report (separate procedure); interpretation only

The CPT descriptor says that this is a service provided only "by [a] consulting physician;" however, it can be used by a family physician who is consulted by another physician.

And I especially love this one:

Maternity Care Services Provided After Hours

Many family physicians do not realize that services provided on Sunday, holidays, or before 8 a.m. of each day their office is open or after the usual time the office closes can qualify for the addition of the following codes:

99050 - Services requested after office hours in addition to basic service

Family physicians may use this code for office or hospital services rendered from the time the office usually closes until 10 p.m. on days the office is usually open (except for Sunday or holidays) and for services rendered on Saturday from 8 a.m. to 10 p.m. (if the office is not open on Saturday).

99052 - Services requested between 10:00 p.m. and 8:00 a.m. in addition to basic service

This code is usually not used for Sundays or holidays.

99054 - Services requested on Sundays and holidays in addition to basic services

Family physicians may use each of the above three codes when appropriate, but most carriers do not reimburse for these additional codes. However, it never hurts to code them since it helps build a case at the insurance carrier for future reimbursement. Some carriers do reimburse for one or two of these additional codes so it is useful to check with each carrier.

Oh, and don't forget to code for that scalp stimulation you did:

Unlisted Maternity Care Services

59899 - Unlisted procedure, maternity care and delivery

Some family physicians have utilized this code to describe the intrapartum services that they provide to their maternity care patients who receive amnio-infusion, scalp stimulation testing, and/or acoustic stimulation of the fetus. However, some carriers will not recognize, nor reimburse, for this code.

There is also a sample letter for the case where care is transferred for the birth itself.