Reader Question:
Labor Epidurals
Published on Sat Apr 01, 2000
Question: Labor epidurals are so common, but it seems like our practice is always getting different opinions from our billing agency or carriers on which codes to use when. Can you offer any suggestions for how we can deal with this situation?
Maryland Subscriber
Answer: Anyone who is familiar with labor and delivery situations knows that no two deliveries are exactly alike. That may be why there are so many questions about the best way to code for epidurals used during labor, and why its important to know what each carrier you work with wants.
First of all, know that youre not alone. Its not uncommon for a doctors office to want to bill one code for a procedure and the billing agency to want to use another one instead. For example, the practice may prefer to bill labor epidurals for cesarean section patients with code 00857 (neuraxial analgesia/anesthesia for labor ending in a cesarean delivery [includes any repeat subarachnoid needle placement and drug injection and/or any necessary replacement of an epidural catheter during labor]). The billing group they work with may prefer to code it as 59514 (cesarean delivery only).
Whatever code your billing agency prefers, it is important for you to work with the agency to determine the best codes. Discuss why you think a particular code is best for a particular situation and decide from there. The most important thing is to report the procedure with the most accurate code that truly represents what was done. Then if more than one code fits the situation, use the code(s) that maximize reimbursement.
The code you use for labor epidurals also depends on the carrier and the circumstances. Most carriers accept any labor and delivery-related codes in CPT 2000, but some may have their own set of codes for labor epidurals that may not coincide with Medicare, American Society of Anesthesiologists (ASA) or CPT codes. Blue Cross/Blue Shield (BC/BS) is one example of this situation. BC/BS of Colorado used to have their own codes for labor epidurals. If you submitted a claim with CPT or ASA codes, they would transfer your code to theirs before reimbursing you. It didnt slow things down too much, but sometimes its best to just call the carrier and ask which code they want so you can get paid appropriately for it.
The first factor to consider when filing for labor epidural reimbursement is whether the baby is delivered vaginally or by cesarean section. Talk with your local carrier to determine which codes they think are best for particular situations, but any of the following codes may be accepted.
If labor and delivery progress with little or no complications, code 59409 (vaginal [...]
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