Trauma Billing

[CajunGas]

My group has been tasked by the hospital to respond to every limited and full activation of the trauma service. This translates into 6-8 times per day that I go to the ED to evaluate a patient for the need for airway management. Is there anything I can bill for this? Thoughts?

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[nimbus]

My group has been tasked by the hospital to respond to every limited and full activation of the trauma service. This translates into 6-8 times per day that I go to the ED to evaluate a patient for the need for airway management. Is there anything I can bill for this? Thoughts?

That's jacked.

As an aside is being belligerent and mouthing off an indication for "airway management"?😉

 

[B-Bone]

You can't bill for it, but if the hospital is changing your coverage requirements, you should negotiate for payment from the hospital, or at least use this as political capital to negotiate something you want (assuming of course that your anesthesia group has an exclusive contract with the hospital and any bargaining power).

 

[deleted162650]

Why not complete an Anes record as bill it as a "MAC" case? Just do a little digging and find an appropriate CPT code.

Otherwise, do what B-bone said.

 

[kazuma]

You might be able to bill a consult if you meet all the requirements. I was told we can bill for being on "standby" for a c-section (example twin delivery in OR, no neuraxial in place) as long as we meet document all the necessary points.

 

[B-Bone]

You might be able to bill a consult if you meet all the requirements. I was told we can bill for being on "standby" for a c-section (example twin delivery in OR, no neuraxial in place) as long as we meet document all the necessary points.

you can bill for anything; whether you get paid for it is another story. While there does exist a CPT code for standby for c/s (99360), there is not a payor out there who reimburses for it (per our billing company).

 

[okayplayer]

you can bill for anything; whether you get paid for it is another story. While there does exist a CPT code for standby for c/s (99360), there is not a payor out there who reimburses for it (per our billing company).

Does this apply to VBACs as well?

 

[urge]

My group has been tasked by the hospital to respond to every limited and full activation of the trauma service. This translates into 6-8 times per day that I go to the ED to evaluate a patient for the need for airway management. Is there anything I can bill for this? Thoughts?

Bill the hospital, i.e. Stipend.

 

[urge]

Why not complete an Anes record as bill it as a "MAC" case? Just do a little digging and find an appropriate CPT code.

Otherwise, do what B-bone said.

That is insane.

 

[urge]

You might be able to bill a consult if you meet all the requirements. I was told we can bill for being on "standby" for a c-section (example twin delivery in OR, no neuraxial in place) as long as we meet document all the necessary points.

That is a Mac case. Being present in the room and monitoring vitals at least q5min

 

[B-Bone]

That is a Mac case. Being present in the room and monitoring vitals at least q5min

Anesthesia billing is based on the surgical procedure (base units), time units, and procedure codes with modifiers thrown in. You don't get paid for a "MAC case", but rather for providing anesthesia for a specific procedure. There is no paying code for "monitoring a patient during vaginal delivery". Ask your billing company. The code I referenced above (99360) is "billable" if you meet certain conditions (requested by another physician, immediately available, at least 30 minutes, not billing for anything else at the time), but even if you "bill" it, third party payor don't generally reimburse for it. You get Boy Scout kudos, but no bling.

 

[urge]

Anesthesia billing is based on the surgical procedure (base units), time units, and procedure codes with modifiers thrown in. You don't get paid for a "MAC case", but rather for providing anesthesia for a specific procedure. There is no paying code for "monitoring a patient during vaginal delivery". Ask your billing company. The code I referenced above (99360) is "billable" if you meet certain conditions (requested by another physician, immediately available, at least 30 minutes, not billing for anything else at the time), but even if you "bill" it, third party payor don't generally reimburse for it. You get Boy Scout kudos, but no bling.

I disagree.

Quick Google search:

HMSA recognizes the following anesthesia CPT codes for anesthesia services rendered during labor and delivery:

Code Description
01960 Anesthesia for vaginal delivery only. [Note: Anesthesia via epidural catheter should be billed using CPT code 01967.]

http://www.hmsa.com/PORTAL/PROVIDER/zav_pel.ph.ANE.300.htm

Hope you are not paying your billing company much.

 

[B-Bone]

I disagree.

Quick Google search:



Hope you are not paying your billing company much.

Of note, I said there's no paying code for anesthesia for vaginal delivery. Ask your company how much they collected for 01960 last year. Also of note, I own my billing company.

 

[urge]

Of note, I said there's no paying code for anesthesia for vaginal delivery. Ask your company how much they collected for 01960 last year. Also of note, I own my billing company.

That webpage was form an insurance carrier saying that it recognizes the billing code. It is recognized even by Medicaid.

I have more faith in supercoder than your billing company.
https://www.supercoder.com/coding-n...0-applies-if-you-dont-insert-epidural-article

http://chfs.ky.gov/NR/rdonlyres/91D4D2F4-7FC0-4093-840F-B5E7F9313172/0/2011physicianfeeschedule.pdf


Just because you don't use it it does not mean it is not paid.

 

[urge]

Here is another insurance carrier:

https://www.nhpri.org/Portals/0/Upl...esthesia_Billing_and_Reimbursement_Policy.pdf

I could go on but it is unnecessary at this point. I rest my case.

 

[urge]

Coup de grace:

http://www.cyfairhospital.com/en-us/documents/cpt product list.pdf


Do you see all those "no longer valid" cpt codes in the page? Yes, 01960 is not one of them.

At this point I honestly believe you owe me money for the education.



PS:

Your grand recommendation of using CPT 99360 yileds this:

CPT code 99360 describes physician standby services requested by another physician involving prolonged physician attendance without direct (face-to-face) patient contact. The Centers for Medicare and Medicaid Services (CMS) does not reimburse for physician standby services. These services are considered by CMS to be included in the payment to a facility as part of providing quality care and are not separately reimbursable. Based on CMS reimbursement guidelines, UnitedHealthcare does not reimburse physician standby services submitted with CPT code 99360.
https://www.unitedhealthcareonline....l/ReimbursementPolicies/SB_Standby_v2011A.htm

 

[B-Bone]

That webpage was form an insurance carrier saying that it recognizes the billing code. It is recognized even by Medicaid.

I have more faith in supercoder than your billing company.
https://www.supercoder.com/coding-n...0-applies-if-you-dont-insert-epidural-article

View attachment 199097

http://chfs.ky.gov/NR/rdonlyres/91D4D2F4-7FC0-4093-840F-B5E7F9313172/0/2011physicianfeeschedule.pdf


Just because you don't use it it does not mean it is not paid.

I'm not arguing that there aren't recognized codes for what you're describing. I'm saying, they are generally not paid. Granted, it appears that if you billed the state of Kentucky for "anesthesia for a vaginal delivery" in 2011, you would have been reimbursed. I know specifically that BC/BS in my state denied payment for 01960 for "anesthesia standby for twin delivery" in the OR, with q5min VS documented, at surgeon request, for >90 minutes, with no other concurrent cases, in 2013. Our company went back and forth with the payor, and were informed that they (as well as Aetna, Cigna, and United, which make up >95% of our private pay billing) do not pay for this. Again, they recognized the code, noted that we met all the criteria for the code, and reiterated that they do not pay for this code. If your experience billing this code has been different, good for you. But to generalize that because a code exists it is universally reimbursed by third party payors is just not accurate. Again, I don't really give a $%^& what you find on the internet. If you get a payor to reimburse for standby for twin delivery, show me the money and tell me how you did it.

I learned absolutely zero about anesthesia billing in residency (as seems to be the norm). I think it behooves us all to learn more about how the sausage is made.

 

[urge]

I'm not arguing that there aren't recognized codes for what you're describing. I'm saying, they are generally not paid. Granted, it appears that if you billed the state of Kentucky for "anesthesia for a vaginal delivery" in 2011, you would have been reimbursed. I know specifically that BC/BS in my state denied payment for 01960 for "anesthesia standby for twin delivery" in the OR, with q5min VS documented, at surgeon request, for >90 minutes, with no other concurrent cases, in 2013. Our company went back and forth with the payor, and were informed that they (as well as Aetna, Cigna, and United, which make up >95% of our private pay billing) do not pay for this. Again, they recognized the code, noted that we met all the criteria for the code, and reiterated that they do not pay for this code. If your experience billing this code has been different, good for you. But to generalize that because a code exists it is universally reimbursed by third party payors is just not accurate. Again, I don't really give a $%^& what you find on the internet. If you get a payor to reimburse for standby for twin delivery, show me the money and tell me how you did it.

I learned absolutely zero about anesthesia billing in residency (as seems to be the norm). I think it behooves us all to learn more about how the sausage is made.

I believe "standby" is universally accepted as "in the lounge drinking coffee with the feet up". Nobody is going to pay for that.