Anesthesia Coding Alert

Hint: Documentation and carrier guidelines dictate coding

A coder recently posted the following question regarding labor epidural time on our Anesthesia Coding Alert Discussion Group:

Question: One of our physicians says that he read you can bill for a labor epidural for up to 15 minutes after the delivery. Is this true? If so, where would I find more information about it? Read on for the skinny on what you can and can't do when submitting claims for this service. Start With Correct Codes Before you even begin to worry about how to bill the anesthesiologist's labor epidural time, you have to make sure you have identified the correct code for the epidural itself. Some carriers require a surgical CPT code for labor epidurals, but most prefer the appropriate anesthesia labor code. Check the carrier's guidelines, but your most common options include:

CPT 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)

CPT 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).

Depending on the situation, you might also need to report one of the two obstetrics add-on codes:

+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). If the carrier requires surgical codes instead of anesthesia codes, Sharon Merrick, CCS-P, coding and reimbursement analyst for the American Society of Anesthesiologists, recommends 59409 (Vaginal delivery only [with or without episiotomy and/or forceps]) for an uncomplicated vaginal delivery. Double-Check How to Report the Time Next, check your physician group's policy for reporting the anesthesia provider's time during labor cases. Billing for the amount of time involved with each procedure (along with the appropriate anesthesia code) is unique to anesthesia billing. No "official" rules regarding labor epidural billing exist, which makes these cases especially tricky.

Start with a good understanding of what "time" really is. The American Society of Anesthesiologists (ASA) defines anesthesia time as follows: "Anesthesia time begins when the anesthesiologist begins to prepare the patient for anesthesia care in the operating room or in an equivalent area, and ends when the anesthesiologist is no longer in personal attendance, that is, when the patient may be safely placed under postanesthesia supervision."

According to this definition, the physician in this case must be in personal attendance (known as "face-to-face" time) for the 15 [...]