5160-4-21.1 Anesthesia for neuraxial analgesia for obstetrical services.

(A) This rule applies to the following obstetrical care anesthesia procedures:

(1) Neuraxial labor analgesia/anesthesia for planned vaginal delivery (this includes any repeat subarachnoid needle placement and drug injection and/or necessary replacement of an epidural catheter during labor); and

(2) Anesthesia for cesarean delivery following Neuraxial neuraxial analgesia/anesthesia.

(B) All of the provisions of rule 5101:3-4-21 of the Administrative Code apply to anesthesia services for the obstetrical anesthesia listed in paragraph (A) of this rule, except for:

(1) Paragraph (B)(3) of rule 5101:3-4-21 of the Administrative Code, which defines"time unit";

(2) Paragraph (C)(2) of rule 5101:3-4-21 of the Administrative Code;

(3) Paragraph (C)(4) of rule 5101:3-4-21 of the Administrative Code; and

(4) Paragraph (D)(3) of rule 5101:3-4-21 of the Administrative Code.

(C) In the case of anesthesia for obstetrical services listed in paragraph (A) of this rule, "time unit" shall be defined as "time begins when the neuraxial labor analgesic is inserted and continues through delivery."Time for obstetrical anesthesia is the lower of actual time from insertion through delivery or a maximum of four hours.

(D) The department will reimburse for neuraxial analgesia for obstetrical services if the following conditions are met:

(1) For each patient, the physician, must:

(a) Perform or approve a pre-anesthesia examination and evaluation for labor analgesia performed by a qualified anesthesia provider;

(b) Prescribe or approve an anesthesia plan;

(c) Personally participate in all critical portions of the procedure, including placement of the epidural or other regional technique;

(d) Ensure that any procedures in the anesthesia plan that he or she does not perform are performed by a qualified anesthesia provider;

(e) Periodically monitor the course of anesthesia/analgesia administration or ensure that a qualified anesthesia provider performs the monitoring;

(f) Remain readily available for immediate diagnosis and treatment of emergencies as required by Ohio statute; and

(g) Provide indicated post-anesthesia care.

(2) If medical supervision is provided for neuraxial analgesia and the "AD" modifier is billed, the physician must be involved in the pre-procedure anesthesia services.

(a) Medical supervision applies to labor analgesia services when:

(i) The anesthesiologist is supervising more than four concurrent surgical anesthesia procedures while supervising a critical portion, e.g., epidural placement of a labor analgesia technique;

(ii) The anesthesiologist is supervising more than four epidural placements at the same time; or

(iii) The anesthesiologist is not in the obstetrical suite while supervising the critical portion of of the neuraxial technique.

(b) Paragraph (D)(1)(c) of this rule does not apply to medically- supervised labor analgesia services.

(E) In the event that anesthesia for surgery is required during the course of a labor analgesic technique, i.e., cesarean section, the provisions outlined in paragraph (C) of rule 5101:3-4-21 of the Administrative Code apply.

Effective: 10/01/2006
R.C. 119.032 review dates: 06/15/2006 and 10/01/2011
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.01 , 5111.02 , 5111.021
Prior Effective Dates: 1/01/02