CLINICAL NOTES
Midwifery Prenatal Care Linked to Fewer Birth Interventions
CODING CORNER
Global Obstetric Codes: Accounting for Productivity
Midwifery prenatal and labor care at a freestanding birth center may be related to improved maternal and infant outcomes, according to the findings of a retrospective study published in Health Services Research. Compared to women who received usual care, researchers found that midwifery care was associated with lower rates of cesarean birth, electronic fetal monitoring, and preterm birth, as well as a higher birth weight. Learn more at http://bit. ly/11arPqD. Free registration to Medscape is required to view the article.
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by Joan Slager, CNM, DNP, CPC, FACNM, ACNM Treasurer
Fewer Unnecessary Early Deliveries Seen in Multistate, Hospital-based Study
idwives are frequently challenged with how to bill or account for productivity when providing a portion of the global obstetric services. Coding Corner has previously addressed the unbundling of global obstetrical codes, thus answering the question from a coding perspective. Yet it is often the case, despite correct coding, that there are separate billing issues to consider. This article cannot address every scenario, but instead will outline necessary questions to be asked and satisfactorily answered in these cases. Consider the following example: a woman receives all of her prenatal care from a midwife or midwife group, goes in to labor and eventually requires operative delivery (vacuum, forceps, cesarean) by a physician. If the midwife works in the same practice as the physician, how the bill is generated may depend on the financial arrangements in the practice and their internal mechanism for allocating revenue to each provider. If the midwife is neither employed by nor working in the same group as the physician, the billing gets more complicated. FIRST: Determine what state law says about the contractual relationship between midwives and physicians. Some states do not allow a midwife to employ a physician, thus the midwife cannot bill the global fee and pay the physician for performing the cesarean. Each must bill separately for services performed. The physician bills for the delivery and the midwife for antepartum and postpartum care and possibly face to face inpatient services. SECOND: Examine institutional rules and regulations. Does the facility grant full admitting privileges to midwives? If not and all services are billed under a physician, again, an internal mechanism for allocating revenue and/or productivity is required to accurately account for work done by the midwife. THIRD: What does the payer contract language say about billing for midwives? Do midwives bill under their own provider number? Can you unbundle obstetric global services? Will the payer reimburse 2 providers for obstetric service for one patient? When a midwife and physician work collaboratively within the same practice, an internal mechanism should be developed to credit the midwife for care provided. There are many workable arrangements that fairly distribute productivity in these cases. A general rule to follow is to consider that 4% of the relative value units (RVUs) for global obstetric care represent antepartum care, the hospital admission in labor represents 36% of RVUs, delivery accounts for 15%, and in and outpatient postpartum care accounts for 8% of RVUs.? [email protected] poorly on heart rate, reflexes, and skin coloring 5 minutes after birth. Read more at http://reut.rs/14XrKXT. Use, 2013, currently available as an early release. The recommendations address a select group of common, yet sometimes controversial or complex, issues regarding initiation and use of specific contraceptive methods. They are intended as a companion document to 2010’s US Medical Continued on page 36
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