Anesthesia Coding Alert

Question: We administered anesthesia for a labor patient that included 60 minutes of face-to-face time during the labor epidural, then the use of an epidural during a cesarean section. Extensive hemorrhaging began when the c-section was almost completed, so a hysterectomy was performed under general anesthesia. Would anesthesia be coded as one encounter, or would it be reported as two procedures? Which anesthesia code would be most appropriate?

Colorado Subscriber  
Answer: Several new anesthesia codes for obstetrical services go into effect this month, so its important to understand the differences between them. Even with the new codes, however, different practices may code the scenario you describe different ways. One option is to bill 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]) for the patients labor and 01969 (cesarean hysterectomy following neuraxial labor analgesia/anesthesia [list separately in addition to code for primary procedure]) as an add-on code for the hysterectomy. Code 01967 is five base units, with add-on code 01969 of five units, giving a total of 10 units to be billed plus time. Be sure to note the hemorrhaging in the patients diagnosis. The total time units reported will cover the other procedures that were performed. If the labor prior to the c-section was extensive, you may want to check with the carrier on its billing guidelines; some carriers cap the amount of time you can bill for a labor ending in cesarean section when the time is extensive.