Anesthesia Coding Alert

When a labor and delivery case spans two days and results in an unplanned cesarean section, payment for the secondary anesthesia hinges on you painting the correct date-of-service story.

Otherwise, the insurer might deny +01968 (Anesthesia for cesarean delivery following neuraxial analgesia/ anesthesia [List separately in addition to code for primary procedure performed]). That's what happened to subscriber Arlene Soriano with Riverdale Anesthesia in Georgia.

The case: A patient began epidural labor on one day that crossed over into the next. On the second day, her physician decided to deliver the baby by c-section. The same anesthesiologist was in attendance for the entire labor and delivery.

Soriano reported 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 first date as the date of service, then coded +01968 (Anesthesia for cesarean delivery following neuraxial analgesia/ anesthesia [List separately in addition to code for primary procedure performed]) for the second day and cesarean section. She listed both codes on the same CMS form.

Challenge: Some payers deny +01968, stating you cannot bill it as a stand-alone code. Is it better to bill both 01967 and +01968 with the actual delivery date, or bill 01967with a two-day span date?

"Most carriers want the date that the epidural started as the procedure start date," says Barbara J. Johnson, CPC, in Moreno Valley, Calif. Taking that into account, here's how to code the case:

• List the first day as the date of service for the claim.

• Report 01967 on the first line of your claim with the applicable beginning and end times.

• Report +01968 on the second line with the cesarean section times.

Date difference: When you move +01968 to the second date of service, Johnson says it gives the payer the impression that the previous day's epidural was a failure and that the second day should be coded with 01961 (Anesthesia for cesarean delivery only). However, submitting the claim as outlined above is a better reflection of the procedure -- and easier to interpret.

"Carriers can understand that you're reporting a twoday case and will process and pay almost immediately," Johnson says.

Carrier check: Labor and delivery services include a large Medicaid population, and each state might have different rules. Clarify guidelines with your local carrier before filing and have documentation supporting how you code in case questions arise.

Look ahead: With the New Year coming soon, remember to pay special attention to labor and delivery cases that cross from Dec. 31 to Jan. 1. You should start a new anesthesia record with the new year, Johnson says.