Changelog

What you will see

A labor epidural line (01967) bills the directed or teaching modifiers only when the record shows that an anesthesiologist was there for the epidural. The autocoder compares the time of the 01967 line with the documented time of each anesthesiologist on the case. This applies when a CRNA, an anesthesiologist assistant (AA), or a resident placed the epidural.

• The time of an anesthesiologist overlaps. The line bills the directed modifiers from your medical direction settings with that anesthesiologist, for example QK for the anesthesiologist and QX on the CRNA line. At a shift change, the night anesthesiologist who directed the epidural can be a different person from the day anesthesiologist who did the cesarean.
• The time of no anesthesiologist overlaps. The case gets one question. For a CRNA placer, the line bills your CRNA-alone setting (QZ with the shipped settings) until the direction is confirmed.
• An AA or a resident placed the epidural. An AA or a resident cannot bill without a directing or teaching anesthesiologist. So the line keeps the directed modifiers, and the coder decides.

For example: a CRNA places a labor epidural early in the morning, and the anesthesiologist's documented time starts at the cesarean delivery hours later. The 01967 line bills QZ, and the coder confirms whether the anesthesiologist directed the placement.

Alert changes

• Labor Epidural Direction Not Shown (new, ob_labor_epidural_direction_unverified). Reviewer: a coder. Type: Compliance, severity 8. It names the placer, the epidural time and the time of each anesthesiologist on the case, and asks whether an anesthesiologist medically directed the placement. In HANK Claim Maker, this Compliance alert pulls a coder by default. It is the one alert for the line: the CRNA-alone audit alert does not appear beside it.
• When your facility requires a directing anesthesiologist for every CRNA line (the hardstop CRNA-alone setting), the CRNA line bills no payment modifier while the question is open. The question then follows that setting: it is a Hardstop, severity 10, for your charge entry team.

In a sample of 2,336 recent fully automated anesthesia cases, 1.4% had a 01967 line, so this question can apply to at most 1.4% of such cases.

When no anesthesiologist has documented time at all, the existing missing-times alert asks instead, so the case gets one question, not two.

What to look out for

• Read the labor note. If an anesthesiologist directed the placement, bill the directed modifiers with that anesthesiologist. If not, keep the non-directed billing for a CRNA, or correct the line for an AA or a resident.
• An anesthesiologist who places the epidural never gets this question.
• Your organization can silence this alert or change who it asks. Your CRNA-alone setting decides what a CRNA placer bills while the question is open, and who gets the question. Ask your Hank representative.

See Obstetric Anesthesia and the Anesthesia Alert Reference.