Anesthesia Coding Alert

Question: Two anesthesiologists administered epidurals on a labor patient at different times on the same day. The first epidural was used during labor, and the second was used during a cesarean section. How should I code for each epidural, and what diagnosis codes apply?

Nebraska Subscriber

Answer: Correct coding for this situation largely depends on the carrier. If the carrier requires American Society of Anesthesiologists codes, 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]) with the appropriate time units. Many coders use diagnosis code 650 (Normal delivery) for this.

If the labor leads to a cesarean section, report that portion with +01968 (Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia [list separately in addition to code for primary procedure performed]) with the applicable time units. You will need a different diagnosis code for this, so check the patient's record for reasons for the c-section. Common reasons include failure to progress (660.6x) or non-reassuring heart rate (659.7x). If the record shows no particular reason, use 669.71 (Cesarean delivery, without mention of indication; delivered, with or without mention of antepartum condition) as the diagnosis.

Code 01961 (Anesthesia for cesarean delivery only) is also for c-sections, but you should use it only when it is a primary c-section that does not involve any labor care. The diagnosis is still 650.

If the carrier requires surgical codes, report 59510 (Routine obstetric care including antepartum care, cesarean delivery, and postpartum care) or 59515 (Cesarean delivery only; including postpartum care) for the c-section, depending on the situation. Most coders report it with one surgical code instead of splitting it into separate procedures as when the carrier requires the anesthesia codes.

When two physicians from the same group are involved in a case, you generally bill under the initial physician or with the physician who spent more time on the case. If the physicians are in different groups, the first physician reports the epidural placement and his or her associated time with the procedure. The second physician only reports the time he or she spent on the case instead of reporting the epidural placement.