Gasline Newsletter October 2006

Volume 8, No. 5

MEDI-CAL MODIFIES BILLING RULES FOR LABOR EPIDURALS

In late September, the Department of Health Services published new rules for billing labor analgesia for Medi-Cal patients. Earlier in the year, CSA representatives met with DHS medical directors and explored ways in which the instructions and billing examples could be clarified to reflect DHS' interpretation of the language. The CSA proposed new language, most of which was accepted by the DHS with some phraseology added by the DHS. To view and download the rules, go to
http://files.medi-cal.ca.gov/pubsdoco/publications/masters-MTP/Part2/anest_m00o03.doc
The changes are indicated with vertical lines at the margins of the pages.

The significant changes and clarifications include:

There is no requirement to document face-to-face time with the patient unless the total time units exceed 40.
Time in attendance is redefined and in some circumstances up to four time units per hour may be billed.
When epidurals are running concurrently or overlapping, the time units must be apportioned and no more than four units per hour may be billed in aggregate.
Billing of overlapping or concurrent epidurals may be simplified by billing one time unit per hour for each.
The definition of "labor and delivery suite" was clarified by a DHS medical director, noting that the labor and delivery area is not confined to the room of the laboring patient, and may be considered the "floor,"? call area, wing—so long as the anesthesiologist is not in another area of the hospital (within reason), or doing a different case and billing for the epidural. The anesthesiologist should be assigned for labor and delivery, in house, and directly responsible for the anesthesia of the laboring patients.

The new billing rules are considered a vast improvement over the previous iteration but unforeseen billing difficulties could occur. The CSA board asks that members and billing services report any problems caused by unintended consequences of the new rules. Please contact CSA CEO Barbara Baldwin to report any problems.

CSA MEMBERS RECEIVE AWARDS AT THE 2006 ASA ANNUAL MEETING, CHICAGO, ILLINOIS

Patricia Kapur, M.D., Delegate to the ASA/CSA Delegation, was honored on Saturday, October 14, 2006, by the ASA Resident House of Delegates for her many years of service to the residents. Dr. Ben Unger, ASA Resident President, presented the award and noted that Dr. Kapur's mentoring influence has been a major factor in the growth of the resident component of ASA.

Congratulations to J. Kent Garman, M.D., who was awarded the "best in show" first prize for his photographs displayed at the 44th ASA Annual Meeting Art Exhibit.

The Western States Caucus of the ASA recognized the many years of service generously given by R. Lawrence Sullivan, Jr., M.D., and to acknowledge Dr. Sullivan's tireless work to assist the Western Caucus in its important work. Dr. Sullivan served as the ASA Director from California since 1998 and stepped down from that position at the close of the 2006 ASA House of Delegates. ASA Alternate Director Linda Mason, M.D. immediately assumed the Director position. The CSA board will elect a new Alternate Director at its next meeting January 13.

Thomas Joas, M.D., was honored with a plaque for authoring the resolution to the ASA many years ago that resulted in establishment of the ASAPAC.

CSA MEMBERS ELECTED TO CMA BOARD OF DIRECTORS

Two CSA members were elected to the California Medical Association's Board of Trustees at the CMA Annual Meeting, October 28-30. Michele E. Raney, M.D., a CSA delegate to the CMA, was elected by the Specialty Delegation and CSA President-Elect Virgil Airola, M.D., was elected by his geographic district.

In addition, Dr. Rebecca Patchin received the Gary F. Krieger Speaker's Recognition Award for her many contributions to the CMA.

Congratulations to CSA's outstanding representatives!

PROPOSED CMS RULE ON LOCKED CARTS

Draft rules for locked cart security that were published in the Federal Register in March 2005 are expected to be adopted sometime in November. Some CSA members have reported that some JCAHO surveyors have interpreted current rules narrowly and cited some for non compliance. Some surveyors, upon being shown the upcoming rules, have used those standards in determining compliance. The draft rules can be downloaded from the ASA web site.

CSA HAWAIIAN SEMINAR

The brochure and online registration are now available on the CSA Web Site for the January 2007 Hawaiian Seminar, January 22-26, at the Hyatt Regency Maui Resort and Spa on Maui. Sign up now for one of our most popular meetings!

CSA/UCSD ANNUAL MEETING AND CLINICAL ANESTHESIA UPDATE

Don't forget to register for the CSA/UCSD meeting this year in San Diego! The meeting will have a slightly different format with more time for you to enjoy San Diego in the afternoons. The scientific sessions will be updates this year rather than reviews and will have a great faculty.

Mark A. Singleton, M.D.
President