Anesthesia Coding Alert

Question: What amount of time should we include on the claim for epidural removal following delivery?

Arizona Subscriber

Answer: You can’t default to a certain amount of time for epidural removal after delivery, because each case is different (including the fact that sometimes the nurse removes the epidural instead of waiting for the anesthesia provider).

Remember: Catheter insertion includes removal, but if your provider documents the time it took to remove the epidural, you can include it in the total amount of “reported” time. You can use this approach if the carrier pays face-to-face time, such as Colorado Medicaid. If the provider doesn’t document the removal time, you can’t report it separately. Instead, simply report the applicable epidural insertion code, such as:

• 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)
• +01968-- Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia (List separately in addition to code for primary procedure performed).