Anesthesia Coding Alert

Question: The anesthesia provider administered an epidural for pain management during a patient's labor. The case converted to a cesarean section. The payer denied the c-section and epidural on the same day. How should we have billed it?

North Carolina Subscriber

Answer: Guidelines for billing 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]) and +01968 (Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia [List separately in addition to code for primary procedure performed]) together vary by payer, which makes these claims tricky. Keep these tips in mind:

• Many payers reimburse both codes, but require the claims on paper with all anesthesia reports showing your provider performed both services.
• Include the anesthesia provider's face-to-face time associated with each code instead of a global start/stop time.
• Report the appropriate complication diagnosis code with 01968. You have many choices depending on the circumstances, such as code family 660-669 (Complications occurring mainly in the course of labor and delivery), 658.8x (Other problems associated with amniotic cavity and membranes), 659.7x (Abnormality in fetal heart rate or rhythm), or others.
• Check your contracts to see whether they include provisions for how to code these situations. If your contract doesn't include guidelines, consider discussing it before renewing with the payer.