This was to have been discussed at the last anaesthetic meeting held on 3 October 2000 but, unfortunately, due to the lack of time this matter was left out.
At the last MAB meeting held on 27
September 2000, there were suggestions that if the anaesthetist who performed
the epidural subsequently provides the anaesthetic for the Caesar as well, then
he should only charge for the Caesar and not for the epidural.
If a second anaesthetist is involved, each anaesthetist will charge separately.
The logic was that it was the same delivery and hence patients would expect to be charged for only one anaesthetic. The analogy given by Dr. Anuar Masduki was that if a patient had a coronary angiogram done and subsequently went on for an angioplasty, he would only charge for the angioplasty and not for the angiogram.
My argument was that they were two completely separate procedures. One was for pain relief during labour while the other was an anaesthetic for an operative procedure. Furthermore, the anaesthetist would be involved in two temporally and spatially separate sessions and very often, he would have gone home in between.
The views of the anaesthetists were sought. Asked to select between the two choices below,
Agree that if the same
anaesthetist performs both procedures, he should only charge for the Caesar.
Regardless of whether it is the same anaesthetist, both procedures should be charged separately.
9 out of 9 selected choice 2, i.e., we all felt that the anaesthetists should each charge separately for each of the procedures done.
Strongly feel : Delink epidural charge from LSCS event.
Push for Epidural as a separate procedure + code and anaesthetist charge A, B, C, D, etc. based on difficulty and time of night, etc.
We may give an epidural discount if pt. goes for LSCS especially if it is the same anaesthetist.
High Risk procedure, fussy patients, awkward hrs., e.g. 4 am.
Alternatively, fix epidural charge at RM 250 if pt. has to go for LSCS.
To allay pat. complaints, they can be told of the epidural charges by midwives beforehand.
Surcharge for epidurals between 1 am and 6 am.. e.g. additional Emergency Consult x A.
Can be sued for epidural problems.
It is 2 procedure. E.g. O & G perform hysterectomy + appendix, he put 2 codes.
Then Caesar may be done under GA even if by same anaesthetist. O & G encourage anaesthetist to not do the LSCS if he did the epidural.
I am actually quite satisfied with the present arrangement, i.e., the epidural for labour is "down graded" to a major consult and the Caesar charge is 35 % of surgeon's charge. The issue is whether the major consult charge is adequate, i.e., if the procedure is done at unsociable hours, whether there will be further discounts on it or a different code should be used instead.
As agreed to Dr. Chan's suggestion
Epidural in labour: 748C irrespective corporate charges, of one anaesthetist or 2 anaesthetist. GA by same anaesthetist, follow 241
No more: 165 A/B/C: to inform D/P; obstetricians.
Speak to obstetricians in O.T. when time avail.
From the CDM, there are 2 separate codes
Lt. heart catheterisation with angiogram: 7013: $232
PTCA 7044 $504
So these are distinct entities. So epidural in labour is a distinct procedure.
My comments are as given in the introduction.
I fully support the second item as these are 2 separate procedures.
No comments.
I feel that the initiation of the epidural for labour has its attendant risks (of headache, decrease BP, etc), responsibility of which has to be borne by the anaesthetist and thus he/she should be adequately paid for his/her efforts. The fact that the pt. has to undergo a Caesarean does not change this. (Right now if the pt. undergoes an LSCS, the initial anaesthetists' fees are relegated to a consultation; which it never only was this)
At LSCS, the fees should be as per LSCS schedule (according to Surgeon code). There should not be an additional regional code for this.
I feel strongly that performing the first epid. procedure can be viewed as the "first consultation". Therefore, it is definitely DIFFERENT from LSCS anaesthesia. Therefore, a SEPARATE charge. Let's not get sentimental about it - It's all a business transaction! Payment for work done.
It is totally different if you have to come back and repeat the epidural insertion, etc. like if the block doesn't work - ah! this second procedure you DON'T charge.