# Billing for Labor Time



## 00023808 (Sep 30, 2010)

I code for certified nurse midwives, and often they are with the patient's during the labor part for hours and then the patient needs a c-section and then the MD comes in and bills for the delivery.  I haven't found codes for this, but the midwives are sure there are codes they can use to bill for the time they spent with the patient during the labor.  Does any one know if there are codes and does anyone know anything about these codes so I can at least know where to begin researching?


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## jdibble (Sep 30, 2010)

I have basically the same issue - we have physicains (called Laborists) who are taking care of the patient's during labor and may or maynot perform the delivery - Can these services be billed? These doctors are independent contractors under our Hospitalist program.


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## sugihara (Oct 2, 2010)

You need to use the hospital prolonged care codes:
99232 or 99233 (subsequent hospital care) (we use this for the first hour of labor mngnt)
99356 (prolonged face-to-face service, first hour) (second hour of labor mngmnt)
99357 (prolonged face-to-face service, each additional 30 minutes) (etc)

We have had very good results obtaining reimbursement for the midwives' labor time when the woman transfered care to an OB during active labor.  Be prepared to appeal denials, however, as the insurers will want to bundle this with the delivery code.

Notes:
Be sure and use the complication dx code with fifth digit -3, since the midwife did not deliver the baby.
Insurers will usually only reimburse for up to 8 hours of prolonged care per calendar day.

For the laborists, it will be harder to receive reimbursement when there are no complications, but you might try 659.83 or 659.93 (other/unspecified indications for care or interventions related to labor and delivery).  We have had very good results with these two codes codes in the past, but not as much recently. Be prepared to send chart notes and explain why it is not included in the global fee.

~Kelli Sugihara
Midwife Billing & Business, LLC


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## jdibble (Oct 4, 2010)

Thanks Kelli for your help.  I will try those ICD-9 codes - but would you bill with the subsequent visit codes and the prolonged codes as you advised for the other question?

Thanks


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## sugihara (Oct 5, 2010)

In thinking about it, the laborists probably have not seen the woman before then, have they?  I have never billed labor management with the initial visit codes, but it would definitely be worth a shot!

If you could let us know your results (paid, denied, etc) as the EOBs come in, we'd all appreciate it, I'm sure!


~Kelli


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## jdibble (Oct 6, 2010)

You are correct in that the Laborists have not seen the patient before.  I will let you know if these visits get paid once I finally get the charges out!  I am waiting for the doctors notes now as they are not dictated but hand written for OB and Peds at our hospital. So frustrating!


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## 00023808 (Oct 7, 2010)

Thanks for the help with the codes.  I was thinking that would be the only other codes to use but they kept insisting it was something else.  I will let them know and hopefully it will help.  Thanks so much again.

I'm sorry I don't know anything about laborists that I wasn't able to help answer the other question.

Chris


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