Anesthesia Coding Alert

Remember, no two deliveries – or coding for them – are ever exactly the same.

Coding for anesthesia during C-section cases can get complicated or tricky, even for experienced coders. Make sure you don’t get tripped up by refreshing your knowledge of how to handle four common scenarios.

Scenario 1: PCA Shifts to C-section Anesthesia

Question: I’m coding for a case in which a patient was not a candidate for a labor epidural. The patient was placed on a remifentanil PCA (patient-controlled analgesia) andsubsequently needed a Cesarean section. Because of the circumstances, my anesthesiologist was present for the entire case. I don’t think I can file with 01961 for C-section delivery only. What do you think?

Answer: Your question doesn’t indicate how long the patient was on the PCA, so we can’t provide a detailed answer. However, you can report 01961 (Anesthesia for cesarean delivery only) with the documented anesthesia time. PCA would not be reported as a separate anesthesia service.

Scenario 2: Account for an Anesthesia Gap Between Labor and C/S

Question: We have different opinions in our office on how to properly report this labor and delivery claim.

A patient in labor was started with a lumbar epidural (LEA). The LEA became insufficient and the patient had no monitoring or medications for about an hour. The patient was taken to the OR for a cesarean section, where the anesthesiologist uses a spinal (SAB) for the procedure. The LEA line was removed in the OR. Since the anesthesia was not continuous from the time of labor through the c-section, what is the best way to code the case?

Answer: As insurance companies do not typically pay by the “type” of anesthesia, the clearest way to explain this scenario is to report 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]) with the associated documented time and diagnosis for the initial labor epidural. Also include add-on code +01968 (Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia [List separately in addition to code for primary procedure performed]) with the associated documented time and diagnosis for the c-section.

Scenario 3: Match the Anesthesiologist and CRNA Codes

Question: The anesthesiologist provided the epidural for the labor portion of a delivery. Then he directed a CRNA during the C-section portion of the encounter. The anesthesiologist bills 01967-AA and +01968-QK or QY. My question is, what does the CRNA bill? Some people in our office say it should be 01961-QX.

Answer: The anesthesiologist and the CRNA should bill with the same ASA codes: 01968 (Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia [List separately in addition to code for primary procedure performed]) with modifier QX (CRNA service: with medical direction by a physician). Code 01961 indicates that only a C-section was performed and that the patient did not receive any labor analgesia/anesthesia, which is not the situation in your case.

In addition, RVG guidelines state that you should not report code 01961 in conjunction with 01967. This patient had a trial of labor. Therefore, it would be inappropriate to bill 01961.

Tip: Be sure the diagnoses for the labor epidural and the C-section are not the same code.

Scenario 4: Planned Vaginal Delivery Changes to C-section

Question: A patient had an epidural for labor from 17:16 to 22:12, and then a C-section and ovarian cystectomy (compound presentation and adnexal complex mass) from 22:12 to 23:10. How do we code this delivery and surgery?

Answer: Anytime a planned vaginal delivery turns into a Cesarean section, report a C-section code for the procedure.

“You should choose to report the highest base procedure(s), which in this case is epidural to c-section,” explains Kelly  D.  Dennis,  MBA,  ACS-AN,  CANPC,  CHCA,  CPC,  CPC-I, owner of Perfect Office Solutions in Leesburg, Fla.

“Planned vaginal deliveries often turn to c-sections,” Dennis adds. You then code the procedure as 01967 and +01968. Code 01967 carries a base unit value of 5; code +01968 has a value of either 2 or 3 units, depending on the insurer.

Important:  Some payers have specific guidelines for these cases. For example, Texas Medicaid rules state that if the physician places an epidural for a planned vaginal delivery and the patient delivers by C-section instead, the “most appropriate” code to use is +01968. Report the total amount of face-to-face time with +01968 (that’s because Texas Medicaid allows you to bill 01968 as a primary code instead of only as an add-on).

If your state’s guidelines say that either 01967 or +01968 is acceptable, check with your payer representative to verify when they expect you to use each code. Assign the diagnosis for the epidural as the principal code associated with the labor epidural, plus include a second diagnosis related to the C-section to explain the circumstances.