Billing for multiple providers managing high-risk patients
Nationwide, there are MFM providers who only bill fee for service in the management of a pregnant patient including delivery planning but do not actually deliver. Unfortunately, all delivery codes include global services upon delivery (Admission, delivery management and the discharge). When this occurs, unbundling for these services can be quite challenging when the MFM specialist is providing portions of the treatment together with multiple providers.
Confused on how to bill for multiple providers who are involved in the delivery planning and management? Let’s take a look at some scenarios and the appropriate way to report them:
1) MFM admits a patient for labor induction with severe hypertension at 36 wks. The hospitals perform the delivery after 24 hours of being admitted. Is this a billable service? If a patient is admitted to be induced and delivers more than 24 hours, this is NOT a billable service even if it took 2-3 days of induction and another group admitted and rounded on the patient daily. The admission and delivery management is included in the delivery CPT code. However, MFM physicians who are fee for service may bill an office visit if the patient was seen in their office and the delivery was planned by the MFM that day or the MFM can negotiate with the hospitals for the admission component.
2) If the MFM admits the patient with no intention to deliver but do so, is this a billable service? Admissions for PROM or preterm labor that are not meant to deliver although will eventually end up with delivery either that admission or a future one can be reported. If another group rounded or admitted that patient, they should get reimbursed for these visits since these are beyond the routine care of a patient and the delivery. If the patient is admitted and the decision to deliver happens on the same day i.e.: (few hours later), the modifier “57” should be appended to the admission code.
3) If the hospitals manage the labor and bills the delivery, but the MFM sees the patient to manage the intrapartum hypertension, are those visits billable? Yes, medical problems complicating labor and delivery management may require additional resources and should be identified by using subsequent hospital visits with modifier 24 regardless if they are your own patient or not.