Anesthesia Coding Alert

Question: How should I bill a labor that converts to a cesarean section? The physician starts the anesthesia during labor, then stops it, then starts it again with the c-section later. I've been billing only the c-section and not reporting the initial labor because I'm not sure how to combine the times (or if it's even possible to do so).

Massachusetts Subscriber

Answer: The answer depends on how you now report labor epidurals. Most coders choose one of four methods: bill for the total case time, report total face-to-face time, bill one unit for each hour the epidural is in place, or simply charge a flat rate. Your physician group should decide which method to use consistently.

Assuming the physician used an epidural to administer anesthesia for both portions, report 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]) for the labor epidural. Bill this using your normal method (e.g., total time, face-to-face), but the end time for this portion will be the minute before the case converts to a c-section.

Then bill the c-section time with +01968 (Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia [list separately in addition to code for primary procedure performed]); this is an add-on code to use in conjunction with 01967. Whichever reporting method your group uses, definitely report the total time for the initial labor and actual c-section.

You should select your diagnosis code based on the reason the physician converted the labor to a c-section. Report the appropriate code from the 669.7x series (codes related to Cesarean delivery, without mention of indication) if you don't know the reason ("1", delivered, with or without mention of antepartum condition, is the most common fifth digit with this code). Some coders recommend adding 662.13 (Prolonged labor, unspecified; antepartum condition or complication) to the labor epidural code.

Suppose your total labor and delivery time was 01:06-12:10, and the c-section began at 11:08. Your labor epidural time was 01:06-11:07, and your c-section time was 11:08-12:10.
 
-- You Be the Coder and Reader Questions were answered by Tammy Reed, CCS-P, billing manager for the department of anesthesiology of Oklahoma University Health Sciences Center in Oklahoma City.