Anesthesia Coding Alert

Question: Would you clarify the difference between delivery codes CPT 01960 and CPT 01967? I've always thought that 01960 is more for MAC vaginal delivery, but my local Medicare carrier doesn't have any information on this.

Texas Subscriber

Answer: Report 01960 (Anesthesia for vaginal delivery only) when you do not use a continuous epidural catheter. You can use it for any other type of anesthesia, other than neuraxial anesthesia during labor, because it includes services similar to those described by 62311 (Injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; lumbar, sacral [caudal]).

Some physicians avoid epidurals (and therefore report 01960) if they have difficulty locating the epidural space. This often happens if the patient is extremely heavy or has a thick layer of tissue over the spine. Anesthesiologists also avoid epidurals when patients have lower back problems (anatomic abnormalities), take anticoagulants or other contraindicated medications, or if the patient refuses an epidural.

Most coders rarely report 01960 because most delivering facilities can provide the monitoring required for neuraxial labor anesthesia as well as the immediate "in-house" anesthesia-provider support it requires. Facilities that don't have these capabilities or that deal with special circumstances that contraindicate neuraxial labor anesthesia can use traditional IV/IM medication during labor and delivery instead; these services don't require anesthesia-provider assistance.

Do not report add-on codes +01968 (Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia [list separately in addition to code for primary procedure performed]) and +01969 (Anesthesia for cesarean hysterectomy following neuraxial labor analgesia/anesthesia [list separately in addition to code for primary procedure performed]) with 01960.

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]) applies to patients who have an epidural (neuraxial anesthesia) for more than one hour of labor and then deliver vaginally. If the delivery converts to a cesarean section, also report 01968 or 01969 as appropriate.