Wiki Epidural for labor & delivery billing

[nagela]

Currently the Anesthesiologist are inserting the epidural catheter, then turns the care over to the maternity nurse (RN not CRNA) and the maternity nurse removes the epidural catheter after delivery. The Anesthesiologist want to bill the start time when the epidural catheter is inserted and the stop when the baby is delivered. Since they do not have any other face-to-face time with the patient after they insert the epidural catheter my stands is they can only bill for the insertion CPT 62319 (Injection, including catheter placement, continuous infusion or intermittent bolus) or they can bill the CPT 01967 (Neuraxial labor analgesia/anesthesia), but only for the total time they spent face-to-face with the patient.
How do others bill for epidural for labor and delivery?

Thanks,
Amy

 

[Deb P]

Billing for Epidural During Labor & Delivery

Since epidural service during labor & delivery are billible in a flat rate vs RVU situation, we bill 01967 with the total time (from placement to delivery). The medication is time released, and pre-set by the anesthetist. We have anes. staff on 24 hour stand by at our facility, so if they're needed, they're immediately available.

Depending on the time, epidural billing is broken down as follows:
1st hour = 4 units
2nd hour = 2 units
3rd & ongoing hours = 1 unit
for a total of 7 units if the epidural is used more than 180 minutes.
CRNA or MD will place the epidural and nursing or the delivery provider will remove after mother delivers.

Here's the link from Medicare. Chapter 12, Section 50 which is titled Payment for Anesthesiology Services starts on page 120. But it doesn't mention anything about who should remove the catheter.

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf

If anyone has further information, please share. Hope this is helpful!