# Coding remifentanil pca  for OB



## chaveje (May 23, 2017)

Hi, I have a case in which a patient was not a candidate for a labor epidural. The patient was placed on a remifentanil pca and subsequently needed a c-section. I am not sure how to code this, because of this patients circumstance my anesthesiologist was present for the entire case.  I dont think i can use 01961 C-Section delivery only (report only when pt has not recieved any labor analgesia/anesthesia care).
Has any one else had this senario? Any help is appreciated.


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## grb1960 (Jan 23, 2021)

I have a case that was labor only using the remifentinal PCA - patient delivered vaginally but not sure how to bill for it? I am thinking it isnt billable becuase the anesthesiologist was not present the entire time. Has anyone seen this scenario and how did you bill it or did you? We have also had cases where the woman chooses nitrous - same situation not constantly monitored so can that be billed? It wouldnt be qualified for timed anesthesthesia or a MAC. Maybe an em charge? or a charge for the administration (hooking up the PCA)?


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## fwnewbie (Jan 25, 2021)

When a doctor orders an IV med there is nothing billable to the physician.  Ordering treatment is part of the the doctor's job and covered in their care of the patient.
A PCA is patient controlled analgesia through an IV. The medication comes to the floor in a cartridge inserted in the IV pump and programmed by the nurse.  No doctor physical bedside involvement needed so no billing needed.

I have no experience with use of nitrous in labor but I don't know how it could be a timed procedure.


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