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