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 [...]
