Anesthesia Coding Alert

Anesthesia for most procedures is charged based on the number of base units for the procedure plus the amount of time spent on it. However, different guidelines apply to obstetrical (ob) anesthesia, depending on the provider, the carrier and the situation. As a follow-up to last month's article (page 9) on the new ob anesthesia codes (01960-+01969) for 2002, we now examine the methods for billing the time for labor epidurals and the benefits and flaws of each.
 
In October 2000, the American Society of Anesthesiologists (ASA) published a list of recommended methods for billing anesthesia, acknowledging that different ones may work better for different practitioners. The group sanctioned four:

 1. base units plus time units (insertion through delivery), subject to a reasonable cap

 2. base units plus patient contact time (insertion, management of adverse events,    delivery, removal) plus one unit hourly

 3. single fee

 4. incremental fees (e.g., zero-two hours, two-six hours, less than six hours).
Some practices also use two other methods of billing for time 5. base units plus time units with no cap, and 6. base units plus face-to-face time with the patient. Based on individual circumstances and contract negotiations, carriers may accept any of these six methods.
 
Providers, even within a single group, vary considerably on which method they use. Many providers use more than one method, depending on the carrier.
1, 5. Working with Base Units Plus Time, with or without a Cap
Charging for base units plus time, with a cap limiting the time, has been the most popular billing method for ob anesthesia. Although reimbursement may not always be higher than with other methods, it is easy to compute and helps claims get processed easily, says Kelly Dennis, CPC, EFPM, of Perfect Office Solutions in Leesburg and president of the Florida Anesthesia Administrators Association. However, it can be more difficult to justify from a compliance standpoint because face-to-face time with the patient isn't documented.
 
A key part of this formula is the definition of a "reasonable" cap for the amount of time being billed and, as Dennis points out, "reasonable" is in the eye of the beholder. Because the ASA has determined that the average labor lasts for four hours, physicians who cap their time in this vicinity are likely to be reimbursed without many questions. But the risk of not receiving reimbursement increases for physicians who set their cap at a higher level.
 
"The physician group is responsible for setting its own fees, but they may have contracted amounts with different carriers," Dennis says. "The fees are usually negotiable, so you may want to negotiate in advance for additional consideration in atypical cases, such as those that last longer. If, however, you have capped your fee [...]