Ob-Gyn Coding Alert

Question: A nurse midwife is joining our practice, a professional corporation. Some of her patients will likely follow her here. Would these patients be new patients or established patients at our office?

Ohio Subscriber

Answer: If the nurse midwife bills for the patient care, the patient would be considered established to the practice because a physician (or other qualified care-giver) of the same specialty has seen her within the last three years. CPT language does not directly address the nurse midwife in its current definition, but the implication is that the qualified care-giver would also meet this definition. It is less clear whether this same interpretation would apply if the nurse midwife was not directly billing for the services, but rather if the services were billed under the physician provider number following incident to rules. Check with your payer before billing if you are unsure.