Anesthesia Coding Alert

Question: One of our anesthesiologists attempted to insert a labor epidural but failed due to a Harrington rod placement from previous back surgery. He feels he is entitled to reimbursement because he spent 2 hours and 5 minutes on the attempt. How can we code this?

Florida Subscriber

Answer: Usually, you still are entitled to bill for an attempted procedure and the time associated with it. However, Medicaid and some other carriers may not pay for it, depending on the local policies. Bill a "0" base for the appropriate procedure code and then your time units; file the claim with reports documenting the time.

You should bill 59409 (Vaginal delivery only [with or without episiotomy and/or forceps]) and modifier -53 (Discontinued procedure) with an explanation in Box 19 of the claim form: "Modifier -53 Insertion of spinal epidural catheter unsuccessful due to Harrington rods, despite numerous attempts."

Be sure to document the baby's birth on the anesthesia record. If the baby was not born that admission, you can use code 644.13 (Other threatened labor; antepartum condition or complication) for the ICD-9 diagnosis code. Because this is a special case, send the documented anesthesia record with the insurance claim to validate the coding. Also consider whether the anesthesiologist recommended alternative therapy when he failed to place the epidural. If so, he could bill for a consultation using the appropriate E/M code based on the information in the care notes.