Anesthesia Coding Alert

Question: We have different opinions in our office on how to properly report this labor and delivery claim.

A patient in labor was started with a lumbar epidural (LEA). The LEA became insufficient and the patient had no monitoring or medications for about an hour. The patient was taken to the OR for a cesarean section, where the anesthesiologist uses a spinal (SAB) for the procedure. The LEA line was removed in the OR. Since the anesthesia was not continuous from the time of labor through the c-section, what is the best way to code the case?

West Virginia Subscriber

Answer: As insurance companies do not typically pay by the “type” of anesthesia, the clearest way to explain this scenario is to report 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]) with the associated documented time and diagnosis for the initial labor epidural. Also include add-on code +01968 (Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia [List separately in addition to code for primary procedure performed]) with the associated documented time and diagnosis for the c-section.