Choosing Between 01967 and 01968
Question: South Carolina Medicaid states, "when a vaginal delivery becomes a c-section and the catheter remains in place for the c-section, you may bill for the vaginal delivery 01967 or the c-section 01968, whichever is the most appropriate. A provider may not bill for both." Reimbursement for both codes is the same. How should I determine which is "most appropriate"?
South Carolina Subscriber
Answer: Anytime a planned vaginal delivery turns into a c-section, report a c-section code for the procedure. Some carriers have specific guidelines for these cases. For example, Texas Medicaid rules state that if the physician places an epidural for a planned vaginal delivery and the patient delivers by c-section instead, the "most appropriate" code to use is +01968 (Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia [list separately in addition to code for primary procedure performed]). Report the total amount of face-to-face time with 01968 (that's because Texas Medicaid allows you to bill 01968 as a primary code instead of only as an add-on).
If your state's guidelines say that either 01967 (Neuraxial labor analgesia/anesthesia for planned vaginal delivery [this includes any repeat subarachnoid needle placement and drug injection and/or necessary replacement of an epidural catheter during labor]) or 01968 is acceptable, check with your carrier representative about when they expect you to use each code.
