jwizle

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Hey guys,

New attending here, can someone elucidate how OB anesthesia billing works for labor epidural infusions ? Do we get to bill that as anesthesia time ?
 

B-Bone

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Jun 22, 2004
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Two ways.
1-Bill for procedure and time you are in the room only. That's what we do given that we don't have dedicated OB anesthesia staff.
2- bill for procedure, time in the room and 1 unit per hour. I believe this requires at least hourly rounding and documentation of pain scores. This makes sense if you have dedicated OB people, CRNAs or residents.

Are you doing your own billing? Otherwise your billing company should be all over this for you.


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SaltyDog

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Two ways.
1-Bill for procedure and time you are in the room only. That's what we do given that we don't have dedicated OB anesthesia staff.
2- bill for procedure, time in the room and 1 unit per hour. I believe this requires at least hourly rounding and documentation of pain scores. This makes sense if you have dedicated OB people, CRNAs or residents.

Are you doing your own billing? Otherwise your billing company should be all over this for you.


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Scenario 2 does not require any hourly rounding or documenting of pain scores. This is how we have billed in both practices I've worked for, and I never charted any vitals or anything else aside from the vitals for the time I was in the room and then the post-anesthesia time vitals.
 

Ezekiel2517

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Jan 21, 2005
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There are other ways it can be billed. There are places where you get a set number of units regardless of time, for example 10 units. Also, it can be billed for more than 1 unit per hour.
 

B-Bone

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Scenario 2 does not require any hourly rounding or documenting of pain scores. This is how we have billed in both practices I've worked for, and I never charted any vitals or anything else aside from the vitals for the time I was in the room and then the post-anesthesia time vitals.
Our billing company won't bill for this. You might look into whether you get reimbursed for it. Not saying you don't; just different than my experience. Devil's advocate point: what "service" are you billing for if you aren't seeing the patient/"managing the epidural"? An analagous situation is a peripheral nerve catheter or epidural for post-op pain control. You only get to bill for those by rounding on the patient daily and documenting your management/plan., not just "letting it ride".
 

B-Bone

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There are other ways it can be billed. There are places where you get a set number of units regardless of time, for example 10 units. Also, it can be billed for more than 1 unit per hour.
We should make a disctinction between what you can "bill for" and what will be reimbursed. Basically you can send out a bill for whatever you want. Each payor has its own criteria for what they will reimburse, which can vary wildly among payor, and even within payors to different groups/billing companies (i.e. some larger groups -think AMCs- get reimbursed at higher rates than others). Here's an example from my state (see page 6 for labor epidurals):

https://www.bluecrossmn.com/healthy/public/portalcomponents/PublicContentServlet?contentId=P11GA_12332857

This lists the services that BCBS will reimburse for. They don't give rates, because different entities negotiate different rates for the same service.
 

KurtBrie

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The short answer is "it depends on your contracts"

Here are some different ways our billing works with different companies etc.

- Medicaid (depends on your state) epidurals are capped at a flat rate for 3 hours. More hours does not pay more even if you come in to bolus less hours pro rates the pay. There is no requirements for face to face billing time (thats on the unit or in the room) so you bill base + time to a max of the flat rate of 3 hours.

- IHS works same as above

- Tricare is MUCH less than all of these. IS capped very low.

- One insurance is base units plus FACE TIME only. So you get the base and 1 unit for every 15 you spend WITH the patient. (horrible)

- Other insurances pay base + time and are capped at a total. So you bill based on your contracted insurance rate till it hits their cap for the epidural.

These are the 3 ways we are billing. So it does depend on your contract.

questions?

Hey guys,

New attending here, can someone elucidate how OB anesthesia billing works for labor epidural infusions ? Do we get to bill that as anesthesia time ?
 
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SaltyDog

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Our billing company won't bill for this. You might look into whether you get reimbursed for it. Not saying you don't; just different than my experience. Devil's advocate point: what "service" are you billing for if you aren't seeing the patient/"managing the epidural"? An analagous situation is a peripheral nerve catheter or epidural for post-op pain control. You only get to bill for those by rounding on the patient daily and documenting your management/plan., not just "letting it ride".
I realize things are different regionally, but our billers told me directly that NO payers currently require a running vitals tally in order to reimburse for labor epidurals (includes both private insurance and government pay). My old group was straight FFS on L&D so I know exactly what I billed/got paid on each account. Plus, I think we would've noticed if we weren't getting paid for any of our labor epidurals ;). Labor epidural billing is it's own little universe not analogous to post-op pain management billing i.e. you can bill (and get reimbursed) for essentially an unlimited number of epidurals being managed simultaneously, and you can bill for epidural management while doing another case like a C/S. You are billing for your time to be available for active management of that epidural the whole time it is running at 1 unit/hr + 3 units to place it and 2 units to close it out after delivery.
 
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aneftp

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Mar 23, 2010
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My wife delivered at orlando hospital in orlando and they collected (not billed. They billed $5100). But collected $3900 for 9 hours of labor epidural plus c/s. Than another $200 for post op pain left catether in overnight.

So I am pretty sure the group (before it sold itself out to Sheridan) was billing per hour unit rate.

Of course we had some insurance called Cigna/great west individual market plan pre obamcare that was likely paying a ridiculous amount per unit rate.
 

Wiscoblue

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Feb 10, 2013
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Here in Wisconsin, some insurers will pay up until time of delivery. I have collected 25-30 units from blue cross. Medicaid is face time only. We bill to delivery for all other insurers.


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Mman

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The answer for private insurers (as mentioned and alluded to) is that it depends on your negotiated contract with them. We get a flat fee for ours unrelated to time it is in place. If they deliver 15 minutes after I place it or 48 hours, it's all the same. I'm not sure how or why it ended up that way, but it's been like that for our group for a long time.
 

SaltyDog

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The answer for private insurers (as mentioned and alluded to) is that it depends on your negotiated contract with them. We get a flat fee for ours unrelated to time it is in place. If they deliver 15 minutes after I place it or 48 hours, it's all the same. I'm not sure how or why it ended up that way, but it's been like that for our group for a long time.
I have been told that are basically given the option on how you would like to bill when you set up your contract - either flat fee or time based.