# CRNA OB Billing



## DStack818 (May 11, 2009)

Can someone please direct me to more information about CRNA's covering epidural's during OB Cases. Do you bill total time or face to face time? I have reviewed the anesthesia answer book but their is some conflicting information for me.


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## jdrueppel (May 11, 2009)

There is not a set standard for OB anesthesia billing.  It's dependent on the level of service that your group provides and what your provider's determine to be fair and reasonable. The 2009 ASA Relative Values Guide (page 22) gives some examples of how OB anesthesia can be calculated.  
Also keep in mind that, even if you choose one of these guidelines, payers may have other guidelines for calculating payment for OB anesthesia.

Julie, CPC


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## DStack818 (May 12, 2009)

Yes, I have read every possibly book internet manual etc....the RVG is too vague also. Do you currently have a group of CRNA's that covers OB charges? We do not report face to face time do you have any concurrency issue?


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## jdrueppel (May 13, 2009)

Yes, we are a group of MDAs and CRNAs.  All services, including the CRNAs, are personally performed and we do provide OB anesthesia services.  For reporting purposes, we enter the total time (start to end) for all OB cases, although that does not mean that we report total time to the insurance carrier - it depends on the billing specification of the insurance payer.  No, we do not have concurrency issues.

Julie, CPC


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## DStack818 (May 22, 2009)

I am just confused because now my CRNA's cannot be in more than one room at the same time with OB, None of my insurances require reporting of face to face time. I have researched every where I know to look. Do you have any suggestions?


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## jdrueppel (May 27, 2009)

DCasey

What state are your CRNAs performing services in?  Are you billing personally performed or medical supervised/directed CRNA services?  Where did you obtain the information that CRNAs could not cover multiple OBs?

This is the second conversation I've heard about CRNAs not being able to cover multiple OB cases concurrently, yet I have not found any documentation that supports this information.

Julie D, CPC


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## DStack818 (Jun 22, 2009)

We are billing medically directed CRNA's. I cannot find any documentation to support it either...that is what is frustrating me. We are in TN. 

Software company changed it and stated that from an excerpt out of the Anesthesia Answer book last updated in 2002 that a CRNA cannot be in more than one place at a time. Which yes I get this but I cannot find anything else that is says specifically that they cannot.


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## jdrueppel (Jun 22, 2009)

You wouldn't happen to have PPM software do you?  If so, I just recently acquired the documentation they are basing this update on and I would be happy to share.  Our group currently does not concur with the interpretation.

Julie, CPC


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## DStack818 (Jun 25, 2009)

Good Guess! Yes we use PPM and no our group does not agree with it either. I have not been able to find any documentation to prove the opposite. I think they are taking one statement out of context. How are you correcting the issue? We may be changing software companies soon. I would also like to ask you if you bill of the RBRVS or do you override flat fees for pain injections 62311?


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## jdrueppel (Jun 25, 2009)

I sent you a private message with my contact info.  Call me if you want to discuss the CRNA OB issue specific to PPM software.  I'm on the CAB Committee and they are hopeful a fix or other options will be available in the next release (3.9.6).
In regards to our surgical services - they are all billed at a flat fee rate.

Julie, CPC


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