time gap from Labor to C/S


San Antonio, TX
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We are split in our office on how to properly capture this unusual delivery for us. Looking for guidance.

Patient in labor is started with an LEA, the LEA becomes insufficient or non effective, no monitoring or meds provided for about approx. an hour. The patient is taken to the OR for a C/S where the anesthesiologist uses a Spinal (SAB) for the procedure. With one of the ladies the LEA was pulled before going to the OR, while the 2nd patient had the LEA removed in the OR but both were not monitored during the time gap.

Since the anesthesia is not continuous for the Labor to C/S:

1) is 01967 & 01968 still applicable? reporting only the time for the LEA and the actual time for the C/S (time gap)
2) is 01967 & 01961 applicable, as it was not continuous?
3) do we bill just for the 01961 for the C/S time only?

some of us feel that 01967 & 01968 option is correct, reporting only the time for both the LEA and the SAB even though it is not continuous. And because the 2017 Relative Value Guide states do not report 01961 in conjunction with 01967.

some of us feel 01967 & 01961 are correct because it was not continuous.

the 3rd option was just a thrown out as a thought with no real justification.

Any help, advise or documentation to help us submit these encounters correctly would be greatly appreciated.

Thank you for your time in advance.


Best answers
My experience has been

We would code the 01967 from the time they placed the epidural to the time that they discontinued any monitoring and care was turned over to a different team and anesthesia staff was no longer responsible for her and then start the time for the c-section when the anesthesia staff documents they are ready and monitoring the patient to the time of delivery. We generally allow 30 min. after the birth of the neonate. Regardless as to if the catheter has been pulled or not. A lot of the time the nursing staff that our team turns the patient over to will remove the epidural and our doctors will make note of it when they are charting. So in the short answer... bill for the time that they anesthesia doctors were responsible for the patient.
i.e. epidural placed 0900 and it the medication was discontinued at 1200, but the catheter could still be in place, they just were not pushing any meds through it... 0900-1200 would be 01967 then they decide to go ahead with the c-section at 1430 and baby was born at 1500. If they had done the machine checks and were ready to start the monitoring at 1445 then the time would be 1445-1530 for 01968. Hope that helps. Heather