Anesthesia Coding Alert

Question: An expectant mom received a labor epidural for Baby A from 12:00-13:45, then had anesthesia for a cesarean section from 14:00-15:00 to deliver Baby B. How should this scenario be coded?

South Carolina Subscriber

Answer: This situation is easier to code than ever before, thanks to the obstetrical anesthesia codes added to CPT 2002.

Although multiple babies are involved, your main concern is coding for the mother's anesthesia a labor analgesia via epidural catheter that resulted in a vaginal delivery, followed by anesthesia for a cesarean section. For Baby A's delivery, use 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]). When a cesarean delivery follows neuraxial labor analgesia, code 01967 becomes a "primary" code; the operative delivery is indicated by an add-on code.

Report Baby B's delivery with +01968 (Cesarean delivery following neuraxial labor analgesia/anesthesia [list separately in addition to code for primary procedure]). Some coders may recommend that you also include code +99140 (Anesthesia complicated by emergency conditions [specify] [list separately in addition to code for primary anesthesia procedure]) for Baby B. Divide the charges for time units according to each delivery (and note that code 01968 carries three additional base units).

Appropriate diagnosis codes for the deliveries include 651.01 (Multiple gestation; twin pregnancy; delivered, with or without mention of antepartum condition), 652.23 (Malposition and malpresentation of fetus; breech presentation without mention of version; antepartum condition or complication) or 662.3 (Long labor; delayed delivery of second twin, triplet, etc.).