Whose billing for CONTINUOUS epidurals?

[sevoflurane]

So we get a flat fee for our epidurals... and don't bill for continuous epidurals. Pop ‘em in between cases and then go back down to the main OR.

The main reason we want to start doing this is the ever annoying VBAC’s. We place epidurals for them, but are now contemplating billing as continuous as we need to stay in the hospital until they deliver.... so might as well bill for it too.

When rotating through a high volume OB hospital a while back, we’d pop in tons of epidurals and had the CRNA’s round every 15 minutes and chart some vitals, asses levels, and go up or down on the rate if necessary. This was then billed as continuous.

What do you do in your practice? Continuous epidural...? If so, what do you document and what is the modifier/cpt code?

Thx.

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[Noyac]

We just bill a flat fee. We are not in house for VBACs. P

 

[deleted126335]

We just bill a flat fee. We are not in house for VBACs. P

Danger. Will Robinson??

 

[Noyac]

Danger. Will Robinson??

Yes but our OBs are also not in house for VBACs so the standard has been set.

Officially, we dont do VBACs.

 

[Gern Blansten]

Officially, we dont do VBACs.

 

[Noyac]

You got it!

 

[periopdoc]

We bill the starting fee then one unit per hour for something like six to eight hours. From 6AM-6PM ish we have a guy in house assigned to cover OB as well as run the board etc. From 6PM-6AM and on weekends we cover it from home whether we have an epidural running or not. We do stay in house for all VBACs as do the OBs.

We are discussing what to do when the OB calls us in to "push in the OR" because of a concerning tracing. Some of us feel this should be 1 unit per 15 min work. Some of us feel this is covered under our 1 unit per hour setup. No one is certain what to do if the usual 1 unit per hour billing time has run out.

- pod

 

[sevoflurane]

We bill the starting fee then one unit per hour for something like six to eight hours. From 6AM-6PM ish we have a guy in house assigned to cover OB as well as run the board etc. From 6PM-6AM and on weekends we cover it from home whether we have an epidural running or not. We do stay in house for all VBACs as do the OBs.

We are discussing what to do when the OB calls us in to "push in the OR" because of a concerning tracing. Some of us feel this should be 1 unit per 15 min work. Some of us feel this is covered under our 1 unit per hour setup. No one is certain what to do if the usual 1 unit per hour billing time has run out.

- pod

How are you documenting? Vitals qhr... No ducumentation? When you submit your biling what are you submitting? Are you billing for a continuous epidural even if you are home and have an epidural running?

This seems to be a grey area... I found this on the net.

Tip 3: Decide How to Bill Time
One unique aspect of anesthesia coding is reporting the time involved with each procedure along with the appropriate code. Your job as a coder becomes even more challenging because there are no \written-in-stone\" rules for billing the time associated with labor epidural cases.

Guidelines: Several methods of billing OB anesthesia exist. The American Society of Anesthesiologists (ASA) acknowledges that different methods may work better than others for different practitioners:

Base units plus time units (catheter insertion through delivery), subject to a reasonable cap: This is the most popular billing method for OB anesthesia. It is easy to compute and helps claims get processed easily, but can be difficult to justify from a compliance standpoint because face-to-face time with the patient is not documented. Another caveat is determining a \"reasonable\" cap; the ASA has determined that the average labor lasts for four hours, so physicians who cap their time in this vicinity are likely to be reimbursed without many questions.

Base units plus patient contact time (insertion, management of adverse events, delivery removal), plus one unit hourly: This is another popular billing method, partly because documentation usually supports it. Another plus is that the extra unit per hour recognizes that the anesthesiologist should be reimbursed for his availability in case an emergency arises, even if he does not see the patient during the hour.

Some coders recommend reporting the hourly unit as standby time (99360, Physician standby service, requiring prolonged physician attendance, each 30 minutes [e.g., operative standby, standby for frozen section, for cesarean/high-risk delivery, for monitoring EEG]) and coding actual patient contact time separately.

Single fee — Some carriers pay a flat fee for OB anesthesia, which makes this a convenient billing option. But since carriers as a whole are accustomed to reimbursing anesthesiologists according to base units plus time, some may question claims using this method. It can work well in some cases, but be sure the carrier knows the reasons behind it.

Incremental fees (for example, zero-two hours, two-six hours, more than six hours): Some groups set their fees according to a base fee amount (which can vary depending on the local market), plus the approximate number of time units for different increments. For example, a physician might charge $750 for two hours or less, $1,000 for two to six hours, and $1,500 for cases lasting more than six hours. Advocates of this method say the time ranges balance each other in the long run.

Reporting base units plus time without a cap: Anesthesiologists get good reimbursement with this method, but they don't use it very often because it's often viewed as less fair than the other methods. \"It tends to alienate the surgeons if they find out the anesthesiologist received more for epidural services than the obstetrician did for treating the patient for her entire pregnancy,\" Dennis says.

Reporting base units plus face-to-face time with the patient: This is the safest or most conservative way to bill OB anesthesia. The coding is simple to report and you always have the documentation to support it, but it also decreases physician reimbursement.
Opportunity: Carriers may accept any of these methods, depending on individual circumstances and contract negotiations. Work with your carriers and your group to determine the best method for your practice.


http://www.supercoder.com/articles/...ip-verify-labor-epidural-codes-with-carriers/

 

[bostonblaz]

I belive they cap at a certian point no matter what. Unless you are getting q5 min vitals and billing like an or case and if that is the case it is not cost effective. Blaz

 

[periopdoc]

PM sent

-pod