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Sample HCFA Statement

Practice Variation in Cesarean Rates: Not Due to Maternal Complications
This brief but well-referenced post analyzes cesarean rates relative to differences in maternal diagnoses or pregnancy complexity. On average, the likelihood of cesarean delivery for an individual woman varied between 19 and 48 percent across hospitals.”

Birth attendants often claim that their high cesarean rate is due to their clientele - that they provide care for a lot of high-risk clients.  This analysis shows that:

    Among lower risk women, likelihood of cesarean delivery varied between 8 and 32 percent across hospitals.
    Among higher risk women, likelihood of cesarean delivery varied between 56 and 92 percent across hospitals.
    Hospital variability did not decrease after adjusting for patient diagnoses, socio-demographics, and hospital characteristics.

This shows that practice variation in cesarean rates is real, substantive, and not just a reflection of the mother’s risk level.

Tips for Choosing a Care Provider - great overview! from Henci Goer

Here's the basic information that should be on every invoice to be submitted as a claim for insurance reimbursement.  The client needs to attach their claim form along with this invoice.  It is always helpful to supply an additional letter supporting doula services, benefits, etc.

This example is for doula services with two prenatal appointments, attendance at the birth in the hospital, and a postpartum followup appointment.

In general, you want to use a diagnosis that best supports the medical necessity of the services provided. In particular, if you're assisting with a VBAC, this is an excellent justification for insurance reimbursement, since a vaginal birth saves the insurance company the cost of 2 additional days of hospitalization - about $6000.

Here's the set of diagnoses for care provided during the prenatal time:

V22.0 Normal First Pregnancy - only if no complications
V22.1 Other Normal Pregnancy - only if no complications
V23.0 Pregnancy with history of infertility
V23.3 Pregnancy with grand multiparity
V23.41 Supervision of pregnancy with history of pre-term labor
V23.49 Supervision of pregnancy with other poor obstetric history
654.23 Previous cesarean delivery, antepartum condition or complication
659.53 Elderly primigravida (35 years or older), antepartum only
659.63 Elderly Multigravida (35 years or older), antepartum only

And diagnoses for services provided at the birth:

650 - Normal birth
654.21 - Previous cesarean delivery, delivered (VBAC)
659.51 - Elderly primigravida, delivered
659.61 - Elderly Multigravida, delivered
659.81 w/"IHPR" - Other specified indication for care or intervention related to labor and delivery, delivered, w/"Desire for natural childbirth" in Box 19
662.01 - Prolonged first stage of labor
662.01 - Prolonged first stage of labor, delivered
662.21 - Prolonged second stage of labor, delivered
669.71 - Cesarean delivery, delivered

If there were complications during the birth, you could use the diagnosis for the complication, but you need to be qualified to make that diagnosis or get it from the woman's primary care provider.  She could call her OB's office and ask what the diagnoses were, after the birth.

And diagnoses for services provided on a separate episode (or occasion) after the birth:

V24.2 Routine postpartum follow-up

There's a huge set of special diagnoses if you're providing lactation consulting.

About procedure codes . . .

The most specific procedure code for doula service is:

59899 Unlisted procedure, maternity care and delivery


Patient's Name (Last, First, MI):
Patient's DOB:
Pregnancy LMP:
or
Date of Delivery:

 
Diagnosis Item #
ICD-9 Code
Description
1
V22.0
Normal First Pregnancy
2
650
Normal birth
3
V24.2
Routine postpartum follow-up
DATE(S) OF 
PLACE OF SERVICE
PROCEDURES, SERVICES, OR SUPPLIES
Description
DIAGNOSIS CODE
$ CHARGES
DAYS OR UNITS
MM DD YY
12
99344
 Home visit for the eval & mgnt of a new pt (1st Prenatal Home Visit)    
 
1
$150.00
1
MM DD YY
12
99350
Home visit for the eval & mgnt of an established pt (2nd Prenatal Home Visit)
1
$150.00
1
MM DD YY
21
59899
Unlisted procedure, maternity care and delivery - doula labor support services (Use date of birth)
2
$900.00
1
MM DD YY
12
99350
Home visit for the eval & mgnt of an established pt (Postpartum Home visit)
3
$150.00
1
      Total Charges   
$1350.00
 

_________________________________ ____________________________________

<Provider Name, with qualifications, e.g. Jane Superdoula, CD (DONA)> <- License information, if any, e.g. California RN #?????>
Federal Tax I.D. Number (EIN) ??-???????
or
Federal Tax I.D. Number (SSN) ???-??-????
<contact information, e.g. address, phone, e-mail>



This Web page is referenced from other pages containing related information about Money and Paperwork

 




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