Anesthesia Coding Alert

Question:  An obstetrician requested that our anesthesiologist place a labor epidural for a patient with a twin pregnancy. The patient hoped to deliver by natural childbirth, but the OB wanted the epidural inserted in case the patient required labor anesthesia or an emergency cesarean section. The anesthesiologist did not administer any medication via the epidural. What is the most appropriate way to bill for the anesthesiologist’s services?

Oklahoma Subscriber

Answer: According to the American Society of Anesthesiologists (ASA), "professional charges should reasonably reflect the cost of providing labor anesthesia services as well as the intensity and time involved in performing and monitoring any neuraxial labor service." There are several different methods of reporting the service provided – although some carriers may have their own policy or methodology for payment. Bill the service based on time with 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]) or 01968 (Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia [List separately in addition to code for primary procedure performed]), as appropriate. ASA listed options for reporting time are as follows:

Option 1: Bill base units plus time reported in minutes, subject to a reasonable cap.

Option 2: Bill base units plus one unit per hour for anesthesia service management plus direct patient contact time.

Option 3: Bill incremental time based fees.

Option 4: Bill a single fee.