OB Series Part 1: Understanding ASA’s Proposed Methods and Payer Requirements

Coding obstetrics in anesthesia is a challenging topic as it varies from typical surgical anesthesia services. Considering all of the variables that can occur during the delivery process, the American Society of Anesthesiologists (ASA) has proposed four methods for practices to submit reasonable costs for anesthesia during labor.  

• Base units + time reported in minutes (insertion through delivery) with a reasonable cap
• Base units + one unit per hour (time captured in minutes) plus direct patient contact time
• Incremental time-based fees (e.g. 0<2 hrs, 2-6 hrs, >6 hrs)
• Single fee

While the four methods proposed by the ASA are widely used, it should be noted that individual payers may have their own requirements.  For example, some payers may allow base + direct patient contact time only.  This direct patient contact time is typically referenced as “Face to Face” time, or the abbreviation F2F.  

It should also be noted that while delivery often signifies the end of anesthesia time as identified in the first bullet option, the ASA and some payers recognize the delivery of the placenta or episiotomy/laceration repair as acceptable end times.  

So how should a practice approach labor encounters? 

The first step is to understand the payer mix and their reporting requirements that cover the practice to ensure the appropriate documentation is captured for all labor encounters consistently.

We can help. Contact the ACE/HANK Team.

Check out OB Series Part 2: Documentation Considerations for more on coding obstetrics in anesthesia.