Anesthesia Coding Alert

Anesthesia or surgical codes might applyCoding for labor epidurals is a lot like dealing with the obstetrics patients themselves -- no two cases are exactly alike, which leads to several coding challenges. Read on for tips on handling these cases, fresh from the AAPC's annual conference in Atlanta.Tip 1: Divide Your Labor Codes by Delivery TypeYour first step in coding a delivery is checking whether the anesthetist administered a continuous or noncontinuous epidural. Report noncontinuous (or spinal) anesthesia based on whether the patient had a vaginal or cesarean delivery:

01960 -- Anesthesia for vaginal delivery only (5 base units plus time)
01961 -- Anesthesia for cesarean delivery only (7 base units plus time)Though 01960 and 01961 apply in some cases, most deliveries include a continuous epidural instead. The primary code for delivery with continuous epidural is 01967 (Neuraxial labor analgesia/anesthesia for planned vaginal delivery [this includes any repeat subarachnoid needle placement and drug injection and/or any necessary replacement of an epidural catheter during labor]).

You can expand your delivery coding with two labor anesthesia add-on codes. CPT 2003 revised these, but many coders - and carriers - still have problems reporting them, says Kelly Dennis, CPC, owner of the consulting firm Perfect Office Solutions in Leesburg, Fla. The codes in question are:

+01968 - Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia (list separately in addition to code for primary procedure performed)
+01969 - Anesthesia for cesarean hysterectomy following neuraxial labor analgesia/anesthesia (list separately in addition to code for primary procedure performed).Remember: You cannot report 01968 or 01969 alone because they are add-on codes. Instead, report either of these codes as appropriate in conjunction with 01967. Primary code 01967 is 5 base units; add 3 additional units for 01968 or 5 more units for 01969, then report the total time represented by both codes.

The code you attribute the total time to (all time with code 01967 or split between 01967 and the appropriate add-on code) will vary by carrier, Dennis says. She cautions coders to ensure they're being paid for both codes plus all appropriate time units.Tip 2: Verify Add-Ons Versus Surgical CPTMost carriers prefer the anesthesia labor codes, which simplifies your job. Some carriers still require surgical CPT Codes for labor epidurals, however, instead of the anesthesia codes. These include:

62311 -- Injection, single (not via indwelling catheter), not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; lumbar, sacral (caudal)
62319 -- Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other [...]