Anesthesia Coding Alert

AAPC Conference Tip:

Verify Labor Epidural Codes With Carriers

Published on Thu May 13, 2004

Anesthesia or surgical codes might apply

Coding for labor epidurals is a lot like dealing with the obstetrics patients themselves -- no two cases are exactly alike, which leads to several coding challenges. Read on for tips on handling these cases, fresh from the AAPC's annual conference in Atlanta.

Tip 1: Divide Your Labor Codes by Delivery Type

Your first step in coding a delivery is checking whether the anesthetist administered a continuous or noncontinuous epidural. Report noncontinuous (or spinal) anesthesia based on whether the patient had a vaginal or cesarean delivery:

01960 -- Anesthesia for vaginal delivery only (5 base units plus time)

01961 -- Anesthesia for cesarean delivery only (7 base units plus time)

Though 01960 and 01961 apply in some cases, most deliveries include a continuous epidural instead. The primary code for delivery with continuous epidural is 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]).

You can expand your delivery coding with two labor anesthesia add-on codes. CPT 2003 revised these, but many coders - and carriers - still have problems reporting them, says Kelly Dennis, CPC, owner of the consulting firm Perfect Office Solutions in Leesburg, Fla. The codes in question are:

+01968 - Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia (list separately in addition to code for primary procedure performed)

+01969 - Anesthesia for cesarean hysterectomy following neuraxial labor analgesia/anesthesia (list separately in addition to code for primary procedure performed).

Remember: You cannot report 01968 or 01969 alone because they are add-on codes. Instead, report either of these codes as appropriate in conjunction with 01967. Primary code 01967 is 5 base units; add 3 additional units for 01968 or 5 more units for 01969, then report the total time represented by both codes.

The code you attribute the total time to (all time with code 01967 or split between 01967 and the appropriate add-on code) will vary by carrier, Dennis says. She cautions coders to ensure they're being paid for both codes plus all appropriate time units.

Tip 2: Verify Add-Ons Versus Surgical CPT

Most carriers prefer the anesthesia labor codes, which simplifies your job. Some carriers still require surgical CPT Codes for labor epidurals, however, instead of the anesthesia codes. These include:

62311 -- Injection, single (not via indwelling catheter), not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; lumbar, sacral (caudal)

62319 -- Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; lumbar, sacral (caudal).

Dennis and others say these codes aren't the most accurate for labor epidurals, but you do want to meet carrier guidelines.

Important: Check with individual carriers to verify whether they accept the anesthesia add-on codes or if they require 62319 instead.

Even if the carrier requires 62311 or 62319 for the labor epidural, they normally consider reporting either of these with 01967 for the actual delivery to be double-billing. If your carrier does allow you to report both codes, get clear documentation of the policy and don't bill other carriers this way.

Remember: National Correct Coding Initiative (NCCI) edits prohibit billing codes 62311 and 62319 with labor code 01967. Many carriers follow NCCI, so adhering to those guidelines is a good idea.

Coders such as Barbara Johnson, CPC, MPC, president of Real Code in Moreno Valley, Calif., don't know of any carriers that require 62319 instead of the labor anesthesia codes, but she does say that it can apply to certain situations. She recommends reporting 62319 for epidurals that failed if the anesthesiologist does not attempt any further placements.

Tip 3: Decide How to Bill Time

One unique aspect of anesthesia coding is reporting the time involved with each procedure along with the appropriate code. Your job as a coder becomes even more challenging because there are no written-in-stone" rules for billing the time associated with labor epidural cases.

Guidelines: Several methods of billing OB anesthesia exist. The American Society of Anesthesiologists (ASA) acknowledges that different methods may work better than others for different practitioners:

Base units plus time units (catheter insertion through delivery), subject to a reasonable cap: This is the most popular billing method for OB anesthesia. It is easy to compute and helps claims get processed easily, but can be difficult to justify from a compliance standpoint because face-to-face time with the patient is not documented. Another caveat is determining a "reasonable" cap; the ASA has determined that the average labor lasts for four hours, so physicians who cap their time in this vicinity are likely to be reimbursed without many questions.

Base units plus patient contact time (insertion, management of adverse events, delivery removal), plus one unit hourly: This is another popular billing method, partly because documentation usually supports it. Another plus is that the extra unit per hour recognizes that the anesthesiologist should be reimbursed for his availability in case an emergency arises, even if he does not see the patient during the hour.

Some coders recommend reporting the hourly unit as standby time (99360, Physician standby service, requiring prolonged physician attendance, each 30 minutes [e.g., operative standby, standby for frozen section, for cesarean/high-risk delivery, for monitoring EEG]) and coding actual patient contact time separately.

Single fee -- Some carriers pay a flat fee for OB anesthesia, which makes this a convenient billing option. But since carriers as a whole are accustomed to reimbursing anesthesiologists according to base units plus time, some may question claims using this method. It can work well in some cases, but be sure the carrier knows the reasons behind it.

Incremental fees (for example, zero-two hours, two-six hours, more than six hours): Some groups set their fees according to a base fee amount (which can vary depending on the local market), plus the approximate number of time units for different increments. For example, a physician might charge $750 for two hours or less, $1,000 for two to six hours, and $1,500 for cases lasting more than six hours. Advocates of this method say the time ranges balance each other in the long run.

Reporting base units plus time without a cap: Anesthesiologists get good reimbursement with this method, but they don't use it very often because it's often viewed as less fair than the other methods. "It tends to alienate the surgeons if they find out the anesthesiologist received more for epidural services than the obstetrician did for treating the patient for her entire pregnancy," Dennis says.

Reporting base units plus face-to-face time with the patient: This is the safest or most conservative way to bill OB anesthesia. The coding is simple to report and you always have the documentation to support it, but it also decreases physician reimbursement.

Opportunity: Carriers may accept any of these methods, depending on individual circumstances and contract negotiations. Work with your carriers and your group to determine the best method for your practice.