Anesthesia Coding Alert

Improve Ob Reporting in 2 Easy Steps

Published on Fri Aug 08, 2003

Anesthesia coders and practitioners welcomed the additions and revisions of Ob anesthesia codes, but that doesn't mean they know how to use these add-on codes correctly. Here are the bare necessities - in a simple, two-step process - for properly using these codes.

Step 1: Understand the Codes' Purposes

CPT designed the Ob add-on codes to be used in conjunction with the planned vaginal delivery code (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]). The add-on codes are:

+01968 - Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia (list separately in addition to code for primary procedure performed); 3 base units

+01969 - Anesthesia for cesareana hysterectomy following neuraxial labor analgesia/anesthesia (list separately in addition to code for primary procedure performed); 5 base units.

These are the only add-on codes in CPT's anesthesia section. Many coders attribute their unique status to the variations that often come into play with obstetrical anesthesia so services can be reported more accurately.

"It also helps reflect the added work involved in these scenarios," says Carolyn MacDonald, CPC, coding manager for New England Health Care Foundation in Boston. "Yes, the pre-op evaluation, IV and periodic monitoring are included, but now the patient needs constant monitoring in the OR, and the anesthesiologist is on alert with medications and such."

For example, many women initially have a labor epidural but progress to a cesarean section during labor for any number of reasons (failure to progress, a rise in blood pressure, or a drop in the baby's heart rate are just three possibilities). Billing for the labor epidural and c-section independently, which is how it was handled prior to the add-on codes, meant the anesthesiologist overestimated his work value since some services (such as preoperative evaluation and IV insertion) for the c-section were included in the labor epidural and shouldn't have been paid twice. But coding for only one type of delivery or the other wasn't fair either. Billing only the c-section sometimes put you at risk for denial because the carrier would think the amount of time billed was unusual for a labor epidural. Billing only the labor epidural wasn't fair to the anesthesiologist because it severely underestimated the work associated with an urgent c-section.

The add-on codes help resolve these situations by giving anesthesia providers the means to report services more accurately even if reimbursement stays the same. For example, the only previous code for anesthesia during a cesarean hysterectomy was 01963 (Anesthesia for cesarean hysterectomy without any labor analgesia/anesthesia care), which doesn't accurately report the situation if the patient began with a labor epidural. Now you have the option of coding a hysterectomy at the time of a c-section following a labor epidural with 01967 and 01969. Both ways of reporting the hysterectomy equal 10 units (10 units for 01963, and 5 units each for 01967 and 01969), but the claim is clearer and the anesthesiologist receives the appropriate reimbursement for his services if you use the two codes together.

"You can report services more accurately with the new add-on codes," says Tonia Raley, CPC, claims processing manager for Medical Information Management Solutions Inc., in Phoenix. "The time involved with a continuous labor epidural does not require the anesthesiologist to be in direct attendance with the patient, but a c-section does. Now the anesthesiologist can report the time accurately along with the work associated with each procedure."

Step 2: Handle 3 Add-On Code Challenges

The Ob add-on codes are helpful in many respects but can also lead to new coding challenges. Consider these ways to handle three common problems.

Denials because of multiple codes: Carriers are accustomed to seeing only one code for anesthesia services, so are sometimes thrown off-course when two codes are reported instead (such as 01967 with 01968). Software should be updated by now, so this shouldn't be a problem. If you're getting denials or must submit supporting documentation to justify using multiple Ob anesthesia codes, work with your carriers to ensure they handle the codes correctly.

Pairing add-on codes incorrectly: Add-on codes can only be reported along with specific codes. CPT states that you submit 01968 and 01969 in conjunction with 01967. Your claims will be denied if you report the add-on codes alone or with any code other than 01967.

Using incorrect diagnosis codes: Raley advises checking with your carriers to learn what they require for reporting the continuous labor epidural portion of the case. "When the physician places the epidural, he doesn't generally know whether the patient will deliver vaginally or by c-section. Only one of your claims might be paid if you use the same diagnosis on both claims." She also adds that using the same diagnosis on both claims doesn't accurately explain the sequence of procedures. She suggests reporting 662.13 (Prolonged labor, unspecified; antepartum condition or complication) for the continuous labor epidural portion and the appropriate diagnosis explaining why the physician performed a c-section.

"Our first challenge with these codes was building them into our anesthesia module," MacDonald says. "Once that was done, the next challenge was monitoring payments. We trained our collectors to send these claims to our anesthesia collection expert so we could be sure we were reporting them correctly and getting the appropriate reimbursement."