Anesthesia Coding Alert

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?

Texas Subscriber

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

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 (Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia [List separately in addition to code for primary procedure performed]). 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 (Neuraxial labor analgesia/anesthesia for planned vaginal delivery [this includes any repeat subarachnoid needle placement and drug injection and/or necessary replacement of an epidural catheter during labor]) 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.