# anesthesia and OB



## eproclaims (Feb 21, 2014)

I need  little input for proper coding of the anesthesia coding related to labor and delivery and how to bill CRNA and MDA charges.  The case situation is that the mother started out with an epidural only under the CRNA (modifier QZ)  Then due to failure to progress the mother had a C-section done.  At that point the MDA became more active in the case and he was present for the C-section along with the CRNA.  All the requirements of billing using QK and QX are met for the c-section part of the day.  My question is how to code the c-secion.  
1. Is it to be coded 01968-QK and 01968- QX in addition to 01967-QZ?  
2. Or is it to be coded as 01967-QZ and then 01961 with QK & QK?
3. Or?

Thanks in advance for any input.


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## hgolfos (Feb 24, 2014)

The straightforward answer is: 01967-QZ, 01968-QK and 01968-QX 

However, with labor and delivery, a lot depends on carrier.  My advice to you is to check with your specific carriers to see if they have any guidelines or policies regarding labor and delivery anesthesia.  If they don't have a policy, then your first choice is the correct way.


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## realtorginac (Feb 24, 2014)

I have a similiar situation. The CRNA was the one who performed the Epidural and will bill the 01967 but the Anesthesiologist was present for Delivery. Since 01968 is an add on code and cannot be billed on its own how could I code for the anesthesiologist? 01961? Then the CNRA would be 01967, 01968 and the anesthesiologist will be 01961?


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## LeslieJ (Feb 25, 2014)

*To eproclaims & realtorginac*

 You both have similar questions! There are some questions to ask:  

1.) Was the anesthesiologist actually medically directing the CRNA during the labor epidural portion of the encounter?
2.) How many CRNA were being supervised by the Medically directing anesthesiologist (MDA) during the c-section?
3.) IF the MDA was present during the delivery, did the MDA do the service or was he/she there for monitoring/assisting?

The answers depend on the type of anesthesia model this group uses and how many CRNA and of course, if MDA is there.

The correct codes would be 01967, 01968 at any rate.

Presuming that there is only a single CRNA performing the labor epidural portion, not under any supervision of an anesthesiologist, then you would code the 01967-QZ.  

From what you state, the MDA was present for the delivery, making this case a medically directed case.  For the anesthesiologist you would bill 01968-QY if there's only the single CRNA being directed.  If the MDA is directing more than one CRNA, the code & modifier will be 01968-QK.

The CRNA would bill 01968-QX.

I hear your concern about the add-on code; some payers want the entire case billed by the same provider from start to finish.  Let's be honest about that by saying that's not always realistic, is it?

However, there are other payers who recognize that one provider may start the epidural while another may end up doing the C-section.  In fact, I was just reading some payer contracts yesterday that did stipulate that it's possible for this and so they will allow payment for this type of situation.

When it comes to this sort of question, it's always best to refer to the contracts and/or payer policy.  You won't know until you ask the questions. Wish I could be more definitive about the payer.

Leslie Johnson, CPC


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