Anesthesia Coding Alert

Question: I’ve been unsuccessful in my search for documentation requirements for obstetric anesthesia, specifically charting for neuraxial anesthesia during labor and delivery. Do you know a reputable source where I can find such information?

New York Subscriber

Answer: You are in luck! The American Society of Anesthesiologists (ASA) published a Timely Topics on coding and billing for labor epidurals in January 2022, which includes documentation suggestions.

“Documentation should include all relevant clinical information. There may also be documentation requirements that are contingent upon the method used to determine fees,” according to Mahesh Vaidyanathan, MD, MBA, in the ASA report. These methods are:

• Base units plus time reported in minutes (insertion through delivery), subject to a reasonable cap. Delivery may include related services such as delivery of placenta or episiotomy/laceration repair.
• Base units plus one unit per hour (time unit as defined by local standards and time reported in minutes) for neuraxial anesthesia service management plus direct patient contact time (insertion, management of adverse events, delivery, removal)
• Incremental time-based fees (e.g., 0<2 hrs., 2-6 hrs., >6hrs.)
• Single fee

The Timely Topic provided suggestions for each of the methodologies, “for example, documentation expectations for methods 1 and 3 are relatively straightforward; beyond a procedure note, documentation should include a pre-operative note, anesthesia start and stop time to capture the time-based total or incremental charge, and a post-operative note.”

The ASA memo also doled out excellent advice, urging coders to keep specific payer requirements in mind. For instance, Medicaid carriers in some states publish stringent documentation requirements for labor epidural patients, while other states are silent.

Do this: Check with each of your state’s major carriers for specific anesthesia policies.

Resource: For more information, see the Timely Topic at www. asahq.org/-/media/sites/asahq/files/public/quality-and-practice-mgt/ timely-topics/2022-01-20-billing-for-labor-epidural.pdf.