Anesthesia Coding Alert

There are 4 core and 2 add-on codes to remember.

Anesthesia providers play a crucial role in obstetrics. These providers ensure maternal comfort and safety during the labor and delivery process. Obstetric anesthesia can present unique challenges for coders and billers. What began as routine anesthesia for a labor may evolve into an urgent cesarean section, or even a hysterectomy.

Accurate billing and coding are essential to ensure proper reimbursement for the full scope of care.

Know How Anesthesia Services Are Utilized and Coded

Anesthesia for obstetrics encompasses a variety of services, including labor analgesia and anesthesia for cesarean delivery or complicated deliveries.

Anesthesia time in obstetrics may often extend over several hours, so it is important to know your payers’ policies regarding time billing in obstetrics. Some payers may accept the entire time, while other payers may accept only the face-to-face time, a capped time, or another variation.

There are four core CPT^® codes for obstetric anesthesia care: 01960 (Anesthesia for vaginal delivery only), 01961 (Anesthesia for cesarean delivery only), 01962 (Anesthesia for urgent hysterectomy following delivery), and 01967 (Neuraxial labor analgesia/anesthesia for vaginal delivery).

There are also two add-on codes for obstetric anesthesia, including +01968 (Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia) and +01969 (Anesthesia for cesarean hysterectomy following neuraxial labor analgesia/anesthesia).

Important: For each of these add-on codes, you must bill 01967 first.

To support accurate billing and coding providers should document the timeline clearly. This should include when the labor analgesia started, the duration, and when the conversion to the cesarean section or hysterectomy occurred. Providers should also note the reason for the conversion, such as failure to progress, fetal distress, maternal complications, or any other reason applicable. Any anesthesia adjustments should also be indicated such as medication, dosage, or change in anesthesia technique.

Obstetric coding and billing can be complex, especially when deliveries evolve into an unplanned cesarean delivery or hysterectomy. Add-on codes are designed to capture these more complex scenarios to bill for the additional work and expertise needed.

Try Coding These Scenarios

The following case examples are simplified clinical scenarios designed to illustrate the fundamental principles involved in coding for obstetric anesthesia.

Scenario 1: The patient was admitted for labor induction. At 9 a.m., a continuous epidural catheter was placed for labor analgesia. The patient reported effective pain relief and maternal and fetal vital signs remained stable. The patient progressed through labor without complication. At 12 p.m., the patient delivered via vaginal delivery.

Coding Guidance:

• 01967 (Neuraxial labor analgesia/anesthesia for vaginal delivery). Total anesthesia time: 12 units (9 a.m.-12 p.m.) or adjusted according to payer-specific policy.
• Apply modifiers, such as medical direction and physical status, as required by payer policy.

Scenario 2: The patient was admitted for labor induction. At 9 a.m., a continuous epidural catheter was placed for labor analgesia. The patient reported effective pain relief and maternal and fetal vital signs were stable at the time of placement. At 11 a.m. an abnormality in fetal heart rate was detected and the patient was transported to the operating room for an urgent cesarean section. There were no additional complications during the cesarean section. Anesthesia care was concluded at 12 p.m.

Coding Guidance:

• 01967 (Neuraxial labor analgesia/anesthesia for vaginal delivery). Total anesthesia time: 8 units (9 a.m.-11 a.m.) or adjusted according to payer-specific policy.
• 01968 (Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia). Total anesthesia time: 4 units (11 a.m.-12 p.m.).
• Apply modifiers, such as medical direction and physical status, as required by payer policy.

Scenario 3: The patient, who has a history of previous cesarean delivery, presented for a scheduled repeat cesarean section. Anesthesia was initiated at 8 a.m. and maternal and fetal vital signs remained stable throughout the procedure. The cesarean section was completed as planned without complications. Anesthesia was concluded at 9:15 a.m.

Coding Guidance:

• 01961 (Anesthesia for cesarean delivery only). Total anesthesia time: 5 units (8 a.m. -9:15 a.m.).
• Apply modifiers, such as medical direction and physical status, as required by payer policy.

3 Key Takeaways for Coders and Billers

Coders and billers can prevent denials and ensure providers are reimbursed correctly for any additional work required in an obstetric anesthesia case. Here are some tips for submitting successful claims:

• Always confirm 01967 is billed before adding either +01968 or +01969.
• Time rules vary. Always check your payers’ policies to determine what is reimbursable for that payer.
• Details drive payment. Clear documentation of start and stop times, reason for conversion, if applicable, and any anesthesia management or technique adjustments all ensure maximum reimbursement.

Julie McDaniel, MHA, CPC, CANPC, Vice President of Operations at Rock Medical Practice Solutions