Anesthesia Coding Alert

Obstetrics Coding:

Cull Through the Choices to Clarify 01967 Usage

Published on Thu Dec 09, 2021

Plus: Confirm when – and if – you need +01968.

With so many scenarios possible during obstetrical cases, correctly coding for the associated anesthesia services always has the potential to get tricky. That can be particularly true when deciding whether to report 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)) since the services represented seem to overlap with some other obstetrical code choices.

Here’s how our expert, Kelly D. Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla., recommends you make those decisions.

Check Whether a C-section Was Planned

Anytime a planned vaginal delivery turns into a C-section, report a C-section code for the procedure (such as +01968, Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia (List separately in addition to code for primary procedure performed)). Some insurers have specific guidelines for these cases, so be sure you understand the parameters for the payer in question.

UnitedHealthcare offers this explanation in its current policy: “Obstetric Anesthesia often involves extensive hours and the transfer of anesthesia to a second physician. Due to these unique circumstances, UnitedHealthcare will consider for reimbursement, add-on CPT^®codes +01968 and +01969 (C-section anesthesia) when billed with the primary CPT^®code 01967 (by the same or different individual physician or other qualified healthcare professional) for the same member. According to the ASA Crosswalk^®time for add-on code +01968 or +01969 is reported separately as a surgical anesthesia service and is not added to the time reported for the labor anesthesia service.”

Caution: Some payer guidelines state that when a vaginal delivery becomes a C-section and the catheter remains in place for the C-section, you may bill for the vaginal delivery with either 01967 or +01968. If you find yourself in that position, check with the payer involved to confirm when they expect you to use each code.

Remember 01967 When No Delivery Occurs

When no delivery occurs and the patient is sent home, submit 01967 with modifier 53 (Discontinued procedure). Also submit diagnosis O60.02 (Preterm labor without delivery, second trimester) or O60.03 (Preterm labor without delivery, third trimester), based on the patient’s trimester.

Example: An expectant mom comes to the hospital at the 31-week mark and is given an epidural. The anesthesiologist later removes the epidural without the expectant mom delivering.

Explanation: From an anesthesia perspective, you’re coding for monitoring services. Years ago, coders reported 62319 for labor epidurals, but that code was replaced by 62326 (Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance) when many epidural codes were revamped in 2017. In today’s coding world, 62326 is set as a flat-fee procedure code and isn’t intended for labor epidurals anymore. Code 01967 is anesthesia-specific and includes time, so is a better choice when no delivery occurs.

Verify Anesthesia Type to Separate 01967 from 01960

Codes 01967 and 01960 (Anesthesia for vaginal delivery only) are both valid procedure codes for reporting anesthesia (or analgesia) for vaginal deliveries, which can lead to code selection confusion. The dividing line lies with the type of anesthesia administered.

Code 01967 is specific to neuraxial analgesia; report 01967 when your anesthesia provider places an epidural or administers spinal mediations during the patient’s labor. Report 01960 in other situations when the anesthesia provider is involved with a vaginal delivery but does not provide labor analgesia. Be sure to read the comments under each of these codes.

Example: The anesthesiologist might be called in for the delivery because the patient is in too much pain or because the obstetrician is having problems. Instead of using an epidural, the provider might administer a spinal block or an injection to ease the patient’s pain. That situation would point you to 01960. Placing a catheter for labor analgesia in addition to being involved with the patient’s labor and delivery justifies reporting 01967.

Don’t Let Physical Status Change the Main Code

The physical status assigned to a patient can help justify anesthesia in some situations and help document the level of risk involved in caring for the patient, although some payers don’t pay additional units for higher physical status modifiers (such as P3, A patient with severe systemic disease; and P4, A patient with severe systemic disease that is a constant threat to life). Adding these physical status modifiers to 01967 is no different than using them with any other case that warrants them.

Also remember that there might be times when the patient’s physical status changes between the time when she presents for delivery (as a P2, for example) and then experiences a problem that requires a C-section (which could shift her status to P3).

Final tip: If you are not sure whether the insurance accepts the modifier, Dennis advises that you include the modifier on the claim. “No insurance will cover unreported services,” she says. If the modifier is not needed, the insurer will ignore it.