Anesthesia Coding Alert

everal areas related to anesthesia coding and billing in obstetrics have either recently undergone or are about to undergo significant change, according to L. Charles Novak, MD, chairman of the American Society of Anesthesiologists (ASA) Committee on Economics and a practicing anesthesiologist in Wenatchee, WA.

Document Time Units for Obstetric Anesthesia

The anesthesiologist or CRNA typically leaves the patient after the initial placement and test dose of a labor epidural, checking back periodically as the labor progresses. Since the physician or another member of the anesthesia team isnt present for the entire labor and delivery, as they are more commonly for a surgical case, different anesthesia providers often use different methods for documenting time units during labor. Using different methods has meant there has been no single, widely accepted method for accounting for time during neuraxial (cerebrospinal-axis anesthesia) labor. Accordingly, reimbursements may vary. The ASA has worked during the past two years to develop guidelines for a charge system that anesthesiologists can follow for this procedure to help standardize time documentation.

The guidelines take into account that professional charges and reimbursement policies should reasonably reflect the intensity and time involved in performing and monitoring any neuraxial labor analgesic, according to the 1999 ASA Relative Value Guide.

The Relative Value Guide (RVG) for 1999 suggests four options for anesthesiologists to consider when billing for neuraxial labor analgesia, says Novak. Having several examples of methods that support the guidelines allows the practitioner to be flexible based on the individual situation, yet still be sure he or she is billing within ASA guidelines.

The four options for accounting for time units are:

basic units plus patient contact time (insertion,
managing adverse events, delivery, removal) plus
one unit hourly;

basic units plus time units (insertion through
delivery), subject to a reasonable cap;

single fee; and

incremental fees based on the number of hours
involved.

These recommendations primarily apply to codes 00955 (neuraxial analgesia/anesthesia ending in vaginal delivery) and 00857 (neuraxial analgesia/anesthesia ending in cesarean section).

We have a flat fee for our labor epidurals, but we still have to report time when we bill the insurance company for the service, says Mary Klein, a coding specialist with Shao, Gincauskas, Bentz and Nalley, MDs, in Pensacola, FL. We start accounting for the time with the initial placement of the epidural and condense the total time spent, to report it as one block of time. For example, if the doctor spends 30 minutes on the initial placement and test dose, then checks back on the patient twice for 10 minutes each time, we report it as 50 minutes.

Most practitioners decide on a standard accounting method and use it for all their cases, Novak says. The method they opt for may be determined in part by the institution where they practice, or by the groups members. In either case, accounting for obstetric time units in a way similar to the examples above will help standardize reimbursement across the country.