Anesthesia Coding Alert

Question: How should I report labor epidurals involving two anesthesiologists (one begins the epidural, and the other takes over when his -on-call- time begins)? Many of our insurance carriers deny the second physician's claim as a duplicate of the first.


Vermont Subscriber

Answer: You have several options for handling these cases. Some groups bill the entire case under the beginning physician's name, some bill by the physician who spent the most time on the case, some groups bill each physician's time on the procedure.

Many coders believe it's less confusing to submit one claim under one physician's name for the entire procedure; they say it balances out between physicians over time. Other coders say single-physician reporting could create concurrency problems for medical direction or be difficult to explain if a law suit develops (after all, how do you explain how a physician not in the hospital could be billing for anesthesia services?). 

If you report both physicians with the case, bill start-up units and time for the first physician and only time units for the second physician. 

If the carrier continues to reject the second physician's claim as a duplicate, call and ask for the carrier's preference in billing the case. Get the carrier's guidelines in writing so you can justify the way you report future cases.