Billing for Nitrous on OB?

[NightNight]

Did a quick search but couldn’t find anything informative.

Where I did residency we routinely used nitrous on OB. Of course, then, I never cared or even considered how we billed for it.

Now in PP at an institution where it has never been used but the OB Dept is making noise about introducing it as an option for any labor patient. Like I said, plenty of experience with it clinically, so am fully aware of its limitations and the extra work/time involved. Don’t need advice or opinion on that, if it were up to me we wouldn’t be doing it but that ship may have sailed.

My question is how do you bill for it on OB? Specifically, what code are you using for billing?

I found this ASA statement that is not really helpful:

Because 01999, in my experience, is a code that nobody actually routinely gets reimbursed for.

Anybody have any thoughts?

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[somedumbDO]

Similar situation at our shop. Ended up we couldn't bill squat, so we made the OBs order and "manage" the nitrous. Funny when they had to wake up at 2 am and put the order in they weren't so excited about this anymore.

 

[IMGASMD]

Similar situation at our shop. Ended up we couldn't bill squat, so we made the OBs order and "manage" the nitrous. Funny when they had to wake up at 2 am and put the order in they weren't so excited about this anymore.

Kinda funny, when people realize that they aren’t paid to do extra work, how fast they run away from it.

 

[Southpaw]

No idea why you’d want to be involved in that. Nitrous will typically involve a birth plan whose sole goal is to avoid ‘anesthesia’ of any sort, or passed on by a midwife or doula who likes to talk about the evils of anesthesia. No clue how nitrous got billed as some amazing safe alternative, but like everything OB it’s like stepping back in time decades. I see it as an OB thing and as such they should be solely responsible for all of it.

I wish I could go so far as to say I wouldn’t offer an epidural to Moms huffing nitrous,
but I realize that’s not realistic.

 

[AdmiralChz]

The inability to bill for it (on both OB and Anesthesia ends) is one of the reasons our hospitals passed on the nitrous systems. They aren’t cheap.

 

[Psai]

They have enough nausea and vomiting as it is

 

[DocVapor]

Recently started the nitrous here. OB's wanted us to manage it, even claiming it as a "learning experience" for residents to come do an eval and consent on every single woman admitted to L+D at 2 am, but none of my attendings wanted anything to do with it. The OB's didn't want to have to get up for it either, and when the midwives started bitching, guess what happened?

A protocol got developed and now the L+D nurses start it.

We tell them that the nitrous better be out of the room before they even call us to come talk to the patient about pain relief techniques that actually work.

 

[Twiggidy]

Did a quick search but couldn’t find anything informative.

Where I did residency we routinely used nitrous on OB. Of course, then, I never cared or even considered how we billed for it.

Now in PP at an institution where it has never been used but the OB Dept is making noise about introducing it as an option for any labor patient. Like I said, plenty of experience with it clinically, so am fully aware of its limitations and the extra work/time involved. Don’t need advice or opinion on that, if it were up to me we wouldn’t be doing it but that ship may have sailed.

My question is how do you bill for it on OB? Specifically, what code are you using for billing?

I found this ASA statement that is not really helpful:

View attachment 239622

Because 01999, in my experience, is a code that nobody actually routinely gets reimbursed for.

Anybody have any thoughts?

I don't get the rationale about why 01960 is applicable if for some reason the OB service has managed to get you guys involved with administering nitrous. It may be off topic but what do you guys bill when you're in the OR for a vaginal delivery in a patient without an epidural?

 

[NightNight]

I don't get the rationale about why 01960 is applicable if for some reason the OB service has managed to get you guys involved with administering nitrous. It may be off topic but what do you guys bill when you're in the OR for a vaginal delivery in a patient without an epidural?

That ASA statement is saying 01960 is *not* applicable for nitrous.
It seems like it would be the appropriate code for the situation you describe in your last sentence.

 

[Twiggidy]

That ASA statement is saying 01960 is *not* applicable for nitrous.
It seems like it would be the appropriate code for the situation you describe in your last sentence.

Oh sorry. That's what I meant. Why is it NOT applicable to Nitrous? The ASA rationale didn't make sense. If you guys are managing the nitrous (god bless you) then that is "anesthesia care" so 01960 SHOULD apply.

 

[NightNight]

Oh sorry. That's what I meant. Why is it NOT applicable to Nitrous? The ASA rationale didn't make sense. If you guys are managing the nitrous (god bless you) then that is "anesthesia care" so 01960 SHOULD apply.

I was initially super confused as well. But someone explained it to me that 01960 is a code for if you haven’t been providing “labor” analgesia, but get called to bedside literally just for the actual vaginal delivery

 

[CubsDynasty]

At an OB anesthesia panel talk a few years ago it seemed like the majority of those who offered it just swallowed the cost. It was used more as a way to market an "alternative" option to certain patient populations but the department didn't make any money on it. There were some who actually believed in their use but those who did and still offered it did as a means to recruit patients to the hospitals in otherwise saturated areas.

 

[Psai]

At an OB anesthesia panel talk a few years ago it seemed like the majority of those who offered it just swallowed the cost. It was used more as a way to market an "alternative" option to certain patient populations but the department didn't make any money on it. There were some who actually believed in their use but those who did and still offered it did as a means to recruit patients to the hospitals in otherwise saturated areas.

Are those really the patients you want to recruit though

 

[abolt18]

Are those really the patients you want to recruit though

I guess it depends on who you're asking.

 

[NightNight]

At an OB anesthesia panel talk a few years ago it seemed like the majority of those who offered it just swallowed the cost. It was used more as a way to market an "alternative" option to certain patient populations but the department didn't make any money on it. There were some who actually believed in their use but those who did and still offered it did as a means to recruit patients to the hospitals in otherwise saturated areas.

Yeah, which I guess is good for the hospital’s bottom line, but not our anesthesia group, if all that extra OB volume isn’t generating any significant new revenue for us. Haha although, given the failure rate of nitrous for labor analgesia, usually leading to an epidural, maybe it would be a backdoor to increased volume. I’m not sure our catchment population is that recruitable just by putting up a “we have nitrous” billboard. Also, yeah, less of those patients anyway, please.

 

[Psai]

Yeah, which I guess is good for the hospital’s bottom line, but not our anesthesia group, if all that extra OB volume isn’t generating any significant new revenue for us. Haha although, given the failure rate of nitrous for labor analgesia, usually leading to an epidural, maybe it would be a backdoor to increased volume. I’m not sure our catchment population is that recruitable just by putting up a “we have nitrous” billboard. Also, yeah, less of those patients anyway, please.

It's like having those midwives as patients. Look, I don't care that you spend your life telling all these women to not get epidurals that you wanted for yourself. Don't take it out on me. I didn't kidnap you and force you to come here.

 

[IMGASMD]

It's like having those midwives as patients. Look, I don't care that you spend your life telling all these women to not get epidurals that you wanted for yourself. Don't take it out on me. I didn't kidnap you and force you to come here.

Haven’t had one of those yet. I’d imaging that’s a pretty fun conversation. But you’re right. I could careless who they’ve convinced.

 

[Twiggidy]

Are those really the patients you want to recruit though

From the OB standpoint, if they have insurance, yes, but I'd be perfectly fine if that's all the pain relief that want and I'll only deal with sane patients.

 

[CubsDynasty]

the failure rate of nitrous for labor analgesia, usually leading to an epidural, maybe it would be a backdoor to increased volume. .

^^this

 

[Twiggidy]

I'm curious. What is your involvement @NightNight when someone wants nitrous, ie, what does the hospital/OB dept actually want you to do? (I'm trying to justify a better code for you)

 

[NightNight]

I'm curious. What is your involvement @NightNight when someone wants nitrous, ie, what does the hospital/OB dept actually want you to do? (I'm trying to justify a better code for you)

TBD, actually. I’m trying to figure out what we can bill for before I tell the hospital/OB how much we are willing to get involved with it.

Honestly, after researching billing for this (or lack thereof), my preference is to have the OB nurses handle the nitrous, call me when they are ready for the epidural and you’ve wheeled the nitrous out.

 

[Twiggidy]

TBD, actually. I’m trying to figure out what we can bill for before I tell the hospital/OB how much we are willing to get involved with it.

Honestly, after researching billing for this (or lack thereof), my preference is to have the OB nurses handle the nitrous, call me when they are ready for the epidural and you’ve wheeled the nitrous out.

That plan makes sense to me. My worry is that they start nitrous on a laboring patient and then start calling you for everything involving the patient, now having you essentially managing the patient. In that scenario you should bill "something" the minute the nitrous is started, but I'd also prefer to avoid that situation. The later is much better, ie, "I'll be involved when the nitrous is out of the room and the patient wants a block"

 

[NightNight]

That plan makes sense to me. My worry is that they start nitrous on a laboring patient and then start calling you for everything involving the patient, now having you essentially managing the patient. In that scenario you should bill "something" the minute the nitrous is started, but I'd also prefer to avoid that situation. The later is much better, ie, "I'll be involved when the nitrous is out of the room and the patient wants a block"

Yeah. I mean if we could bill “something” the minute the nitrous is started I’d be (grudgingly) ok with doing the whole thing, if the hospital/OB decides it’s something they want to offer.

The problem is that “something” sounds like 01999 which I’m skeptical what we would actually get for that.

 

[deleted162650]

I would definitely talk to your major contracted payers to see what if anything they will give you before taking things further with the hospital.