Anesthesia Coding Alert

Question: The anesthesia provider administered an epidural for pain management during a patient’s labor. The case converted to a cesarean section. The payer denied the c-section and epidural on the same day. How should we have billed it?

North Carolina Subscriber

Answer: Guidelines for billing 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]) and +01968 (Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia [List separately in addition to code for primary procedure performed]) together vary by payer, which makes these claims tricky. Keep these payer tips in mind:

• Many payers reimburse both codes but require the claims on paper with all anesthesia reports showing your provider performed both services.
• Include the anesthesia provider's face-to-face time associated with each code instead of a global start/stop time.
• Report the appropriate complication diagnosis code with +01968. You have many choices depending on the circumstances, such as code family O65 (Obstructed labor due to maternal pelvic abnormality), O66 (Other obstructed labor), O76 (Abnormality in fetal heart rate and rhythm compli­cating labor and delivery), or others.
• Check your contracts to see whether they include provisions for how to code these situations. If your contract doesn't include guidelines, consider discussing it before renewing with the payer.