Labor Epidural End Time: What is The Proper Billing Method?
Published on February 1, 2019
Time of delivery?
Time of delivery of placenta?
Time the epidural catheter is removed (full time)?
Face-to-face time only?
Even subjective times, such as 20 minutes post-delivery time?
It states within the Obstetric (OB) Anesthesia section of the ASA Relative Value Guide that, “Unlike operative anesthesia services, there is no single, widely accepted method of accounting for time for neuraxial labor anesthesia services. Professional charges and payment policies should reasonably reflect the costs of providing labor anesthesia services as well as the intensity and time involved in performing and monitoring any neuraxial labor anesthesia service.” (RVG p.23) There are four methods the RVG suggests: 1. Base units plus insertion-to-delivery time units, subject to reasonable cap (can include delivery of placenta or episiotomy/laceration repair); 2. Base units plus one unit per hour plus face-to-face time (insertion, management of adverse events, delivery, removal); 3. Incremental time based flat fees such as 0-2 hrs, 2-6 hrs, >6 hrs; and 4. Single flat fee.
The more popular billing method is base units plus time units, with a cap limiting the charge. The ASA has determined that the average labor lasts around 4 hours, and this is the basis by which most providers choose to set their cap.
The end time can have a bearing if the total billed amount is less than the cap. This is why, to be accurate and consistent, we recommend that the full time (when the catheter is removed) be documented. That way, if the billed amount is under the capped rate, the provider will not be losing money, and any overages will be eliminated by the cap.
It is helpful to understand that although this is the preferred billing method for the majority, it won’t always be the right or advised method for every anesthesia practice. One example is an anesthesiologist practicing in an academic medical center where anesthesia residents are involved in providing services. We performed an internal 4-month survey on an anesthesia practice such as this. The result was 88 labor epidurals performed, with 83 of them being Medicaid payer, 3 Blue Cross Blue Shield, and 2 Self Pay. We advised the practice bill for only the placement time and minimize any compliance risk given that virtually all cases are Medicaid (which will pay their flat fee rate irrespective of time billed).
In short, each of the OB anesthesia billing methods suggested by the RVG are acceptable, with different ones that may work better for different providers. The key is having a knowledgeable and reputable source, such as a dedicated anesthesia billing company, that can best advise the provider.
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RVG (2017). 2018 Relative Value Guide: A Guide for Anesthesia Values. Schaumburg: American Society of Anesthesiologists. 23 p.