Anesthesia Coding Alert

Released in November 2001, the 2002 version of CPT includes many changes that affect anesthesiology coding and billing. While the introductory anesthesia guidelines remain unaltered, the anesthesia section contains a new subsection, 19 new codes, 13 deleted codes, and eight revised definitions. Barbara Johnson, CPC, MPC, professional coder, Loma Linda University Anesthesiology Medical Group Inc. of Loma Linda, Calif., states, "It is apparent that anesthesia has been hit hard with new and revised codes. These changes will help coders accurately report services, and, depending on the base units applied, should better reflect the work done by anesthesia providers."
 
While CPT 2002 is effective Jan. 1, 2002, CMS and private payers have until March 31, 2002, to implement the updated codes. Not all payers adopt changes uniformly. You should check with your local Medicare carrier and private insurers before using any of the revised codes.  
Obstetric Services
A big change within the anesthesia section is a new subsection for obstetrics, containing eight new codes:

01960 anesthesia for; vaginal delivery only
01961   cesarean delivery only
01962   urgent hysterectomy following delivery
01963   cesarean hysterectomy without any labor analgesia/anesthesia care
01964 abortion procedures
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)
+01968 cesarean delivery following neuraxial labor analgesia/anesthesia (list separately in addition to code for primary procedure)
+01969 cesarean hysterectomy following neuraxial labor analgesia/anesthesia (list separately in addition to code for primary procedure).
Scott Groudine, MD, an anesthesiologist in Albany, N.Y., says, "The specific surgical and anesthesia problems of the pregnant woman warrant special treatment. In fact, providing care for obstetrical patients actually requires the anesthesiologist to treat two patients mother and child.
 
"Many women start off requiring a labor epidural and during labor, for a variety of reasons, might progress to a cesarean section," Groudine says. "The new codes +01968 and +01969 will be especially useful in clarifying what services were performed. For example, prior to the creation of these codes, billing for the labor epidural and c-section independently would overestimate the work value, as some of the services for the c-section would be included with the labor epidural. Billing only the c-section might warrant review by the carrier due to the seemingly unusual number of hours for the epidural. Billing only the labor epidural would justify the time but severely underestimate the operative and postoperative work associated with an urgent c-section. The uncertain nature of obstetrics justifies not only new CPT codes that reflect procedures that begin as routine but become more involved but a higher base value for these procedures as well. It is good to see a [...]