Anesthesia Coding Alert

Question: I always wonder if I'm coding epidurals during delivery correctly. Is there a cap for lengthy cases (such as a patient in delivery from 9:04 a.m. until 4:15 p.m.)?

Utah Subscriber

Answer: No national policy for billing labor epidurals exists, which makes the situation tricky for many coders. The American Society of Anesthesiologists recommends choosing one of four methods:

• Basic units plus patient contact time (insertion,management of adverse events, delivery, removal) plus one unit hourly
• Basic units plus time units (insertion through delivery), subject to a reasonable cap Single fee
• Incremental time-based fees (e.g., 0<2 hours, 2-6 hours, >6 hours).

As ASA guidelines state, "Professional charges and reimbursement policies should reasonably reflect the intensity and time involved in performing and monitoring any neuraxial labor analgesia." Verify whether the patient's insurance carrier has guidelines in place. If not, use your best judgment and work with your physicians to determine a group policy that treats both the patient and provider fairly.