Friday 18 October 2013

Claiming for a Labour Epidural

The "stand-alone" labour epidural as well as the epidural followed by a C-Section is  a frequent cause of issues around coding:

This is what Precision recommends to their clients and what has so far kept them out of trouble:

THE LABOUR EPIDURAL:
0151: Pre-anaesthetic consultation
2614: Global Obstetric Care
0023: Actual Time spent with patient - average 45-60 minutes in the "usual" patient
1221: If a PCA pump is set up and managed for infusion

Unless it is an elective induction of labour, the following can be added:
0146/0147 added to 0151
0011 for appropriate time

This far it is fairly straight forward:
Where many complaints come in is when the patient progresses to a C-Section

THE CAESAREAN SECTION:
What can/can't you claim now?
If the same anaesthetist inserted the epidural and charged the 0151, you cannot charge it again.
If a different anaesthetist manages the C-Section, it is appropriate to charge 0151 again.

You can charge the 0146/0147 again as appropriate.
Additional top-up times may be charged for time spent with the patient preparing the patient and epidural prior to admission to theatre.

In theatre:
2615: All inclusive fee for caesarean section
0023: Time spent with patient topping epidural and in theatre
0011: As appropriate

If you use a PCA afterwards a 1221 may be charged. Some confusion is created when hospitals forget to charge for the consumables, making it look as if the PCA was never used.

What is not usually paid for and causes complaints and investigations:
0039: Bloodpressure swings with spinals/epidurals/general anaesthetics happen, managing this is part of the anaesthetic. It is only appropriate to charge this code in obstetric care for the severe eclamptic patient or cardiac patient, and be prepared to motivate your charge.

2801: Insertion of epidural- as this is usually your main anaesthetic and therefore covered by 2614 or 2615, it is not appropriate to charge this as an additional code. This should only be charged if it was inserted for post-op pain control and a general anaesthetic was administered for the C-Section. The associated pain probably doesn't justify this as routine practice.

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