Can nurse-midwife bill for prolonged physician services?
Melanie
Witt,
RN, CPC, MA
Q
How can a certified nurse-midwife (CNM) recoup time spent with a laboring patient when a physician performs the delivery? A seminar speaker once indicated CNMs could bill prolonged physician services. For instance, what if the CNM admits the patient for delivery on day 1 and spends 1 hour with her and then on day 2 spends 6 hours with her before the decision is made to proceed to cesarean delivery?
A
You can only use the add-on prolonged services codes 99356 (prolonged physician service in the inpatient setting, requiring direct [face-to-face] patient contact beyond the usual service; first hour) and 99357 (each additional 30 minutes) if you are also billing for inpatient care and the record clearly documents the need for the prolonged care. Face-to-face time must be documented to use these codes, not unit/floor time. This is one way that the CNM or family practice physician can bill for labor management when they do not do the delivery.
