2 Anesthesiologists charging same code help please!!

Here is my question:

First Dr. came in at 250 did a laboring spinal block (250 to 954). Pt failed to progress
2nd Dr comes in at 650 and placed subsequent continuos epidural for Labor (650-930)
Then patient went on to deliver cesarean. The 2nd doctor feels that he should charge for the 01967 and 01968. But first Dr wants to bill for 01967 also. I do not know how to code this. Im confused because of the over lapping times. I have never seen anything like this before. Any help will be appreciated. Thank you

labor

Were they both anesthesiologist?

labor

yes they are both anesthesiologists.

labor

Presents too many questions to be able to answer, especially if not in same group. I would recommend contacting payer. It is problematic at best. What was actually done?

anesthesia in labor

This may be a case that it would be best for you to call the payer. Here are some thoughts from a more knowledgeable person than I:

Assume that Doc #1 placed an epidural catheter and left it in. The provider would bill 01967 - the next hurdle is who is the payer??? If it is Kansas Blue Shield, or Colorado or New York Medicaid the doctor needs to record his face-to-face time with the patient and the bill will be 01967 x the number of minutes he spent with the patient. If it is NC Medicaid it is 01967 x 1 unit because NC pays a flat fee and wants 1 unit billed. (At least that's what it was the last time I looked at those listed)

There are many versions of how the time is reported for 01967 and many different rules, all depends on the payer. If the payer doesn't have any written instructions then the 01967 is reported in the manner in which the group decided to bill time for this service. There is no standard, the ASA gives 4 options, suggestions only.

Dr. #2 Is he in the same group? If not it is worse than complicated - They need to go to the payer for instructions.

Assume Dr. #2 is in the same group. Code 01967 includes any repeat subarachnoid needle placement and drug injection and / or any necessary replacement of an epidural catheter during labor. Dr. #2 may not report 01967. The codes don't allow 01967 billed 2 times - that isn't an option, same group or not.

The way the times are given in the question, I am guessing that the Doc #1 was responsible for the care from 2:50-6:30. #2 from 6:30-9:54 with the C/S starting at 9:30. I can't figure why Doc #1 listed the full time 2:30-9:54??

The analgesia and responsibility of the providers for 01967 in my assumption scenario would be from 2:50-9:30 and at 9:30 the C/S started. The code 01968 is the add on to 01967 and the time for 01968 would be from start of preparation for the C/S until transfer of care to post anesthesia care staff. So if the C/S is 9:30-9:54 it would be 01968 x 24 min.

labor

Both physicians cannot charge 01967 as the code indicates it includes any repeat needle placement and drug injections or replacement of catheter.