Anesthesia Coding Alert

Question: How should we code if one anesthesiologist begins a labor epidural and another one administers a spinal several hours later and is present when the baby is delivered by cesarean section?

California Subscriber  
Answer: Some practices do not bill separately for the epidural placement and general anesthesia, especially if all physicians in the group bill under the same provider number. In that case, use 00857 (neuroaxial analgesia/anesthesia for labor ending in a cesarean delivery [includes any repeat subarachnoid needle placement and drug injection and/or any necessary replacement of an epidural catheter during labor]) with the appropriate physical status modifier  as determined by the obstetrician. Show total time with the patient, indicating which times were for the labor epidural and which were for the c-section.
 
Another option is to use 00955 (neuraxial analgesia/anesthesia for labor ending in a vaginal delivery [includes any repeat subarachnoid needle placement and drug injection and/or any necessary replacement of an epidural catheter during labor]) with the associated time for the first physician's involvement and 00857 appended with modifier -22 (unusual procedural services) and the associated time for the second physician. If the carrier requires CPT instead of anesthesia codes, bill 62319 (injection, including catheter placement, continuous infusion or intermittent bolus, 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]) with time for the first physician. Use 59514 (cesarean delivery only) appended with modifier -52 (reduced services) with time for the second physician. Attach the appropriate diagnosis code to each service (i.e., 660.63 [failed trial of labor, unspecified, antepartum condition or complication] for 62319 or 660.61 [... delivered, with or without mention of antepartum condition] for 59514) and file the claim with all notes documenting the situation.