Anesthesia Coding Alert

One of the biggest changes to the anesthesia section of CPT Codes for 2002 was the addition of a new subsection of codes for obstetrical services and the deletion of several related codes. With obstetrical anesthesia being such a complex area of care, practitioners and coders welcome the changes as a way to report services more accurately and need to know how to use the new codes correctly.

First Things First: the New Codes

In the past, codes for obstetrical anesthesia were included in the "lower abdomen" and "perineum" sections of CPT, buried among codes for procedures such as "anesthesia for vaginal procedures" or "anesthesia for intraperitoneal procedures in lower abdomen." In addition to making them easier to find, establishing the new codes as an independent subsection allows them to be more specific for reporting. The new codes (and their associated base units) are:
 

 

CPT 01960 anesthesia for; vaginal delivery only (5)

CPT 01961 cesarean delivery only (7)

CPT 01962 urgent hysterectomy following delivery (8)

CPT 01963 cesarean hysterectomy without any labor analgesia/anesthesia care (8)

CPT 01964 abortion procedures (4)

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) (5)

+CPT 01968 cesarean delivery following neuraxial labor analgesia/anesthesia (list separately in addition to code for primary procedure) (2)

+CPT 01969 cesarean hysterectomy following neuraxial labor analgesia/anesthesia (list separately in addition to code for primary procedure) (5).

Anesthesia for abortion procedures (01964) was previously reported with 00940 (anesthesia for vaginal procedures [including biopsy of labia, vagina, cervix or endometrium]; not otherwise specified). This code still exists, but is no longer used for abortion procedures. Many coders are optimistic that having the new, specific code for abortion procedures will make more carriers understand the diagnosis.

The Role of Add-On Codes

The creation of two add-on codes means that sometimes two codes may be used to report anesthesia services add-on codes +01968 and +01969 should each be used along with the primary procedure code 01967 as appropriate. This is the first time anesthesia has had add-on codes, which many practitioners think are needed due to the increased risk, postoperative complications and preoperative conditions requiring one of the add-on services.
 
For example, an epidural is placed for a planned vaginal delivery (01967), but something happens during labor and a cesarian section is required. The carrier understands the situation better because the service is coded as 01967, +01968. Using the two codes gives a better picture of the situation and helps explain why an anesthetic that usually takes less than one hour could have four hours of time submitted as a charge (the time charged would include the time of epidural analgesia provided while a vaginal delivery was still contemplated and the time involved with the c-section).
 
The new codes also mean that anesthesiologists have extra base units for a hysterectomy at the time of a c-section. Although an increase of three units over payment for the same service doesn't seem like much on the surface, Barbara Johnson, CPC, MPC, of Loma Linda University Anesthesiology Medical Group in California says that once it is multiplied by the physician's unit value the reimbursement can add up. For example, if the physician's unit value is $50, he or she will now receive an additional $150 for the procedure.
 
At the same time, however, having two codes to report for procedures may also lead to some initial difficulties until carriers are accustomed to the new system. When an anesthesiologist is involved with multiple procedures, only one anesthesia code is billed (the one with the highest base value). Submitting obstetrical claims with two five-digit codes (because of the new add-on codes) could be a problem if the billing software cannot bill two codes for an anesthesia procedure or if carriers reject the claim because they are used to seeing only one anesthesia code per claim. To overcome these challenges, work with your local carriers to ensure that they are aware of the new add-on codes and can handle them appropriately.

Same Number, Different Descriptor

For carriers that only accept CPT codes for anesthesia, the addition of new code 01961 is not a big deal. But for carriers that accept ASA codes, anesthesia practitioners need to be aware of a difference 01961 was already an ASA code, but was a crosswalk code for diagnostic or therapeutic nerve block injections instead of services related to obstetrical anesthesia.
 
"Many carriers want the CPT anesthesia codes instead of the ASA codes," Johnson says, "so changing the description of a code that very few accept doesn't make a big impact. But carriers in some states accept ASA codes, so they have to make changes when CPT adds a code and changes the description. It's just something that everyone should be aware of, whether you usually file with ASA codes or not."
 
Questions related to the code's proper descriptor will be settled once the ASA's 2002 Relative Value Guide (RVG) is available this spring. Sharon Merrick, CCS-P, coding and reimbursement analyst for the American Society of Anesthesiologists, says the codes for anesthesia for diagnostic or therapeutic nerve blocks and injections (when the block or injection is performed by a different provider) have been renumbered for the 2002 RVG. The new codes are still not included in CPT, but at least will not conflict with current CPT code descriptors.

Oldies No Longer in Use

The introduction of new codes means that several old codes for similar services have been deleted. These include 00850, 00855 and 00857 for cesarean deliveries; and 00946 and 00955 for vaginal deliveries. The five codes were deleted because the new codes have more detailed descriptors to report which services were performed.
 
Fortunately, the new codes apply about the same number of base units to procedures, except for the additional three units associated with +01969.
 
Changes Seen as Positive

Having more obstetrical codes to choose from and codes with more detailed descriptors will allow services to be coded more accurately, which is the goal of all providers.
 
"Having the codes and additional allowances for urgent hysterectomy and cesarean hysterectomy are great assets," Johnson says. "They'll help anesthesiologists obtain more fair reimbursement for more difficult cases. For example, the new codes will help with problems such as a ruptured uterus during labor. This becomes an emergency c-section and hysterectomy, which the anesthesiologist will now get three more base units for."
 
The new codes have been in the works for several years and have advantages for practitioners and carriers. Breaking the codes into their own section makes them easier to use, increases the accuracy of reporting services, and recognizes that obstetrical codes are more than just an afterthought in other sections of CPT.