Anesthesia Coding Alert

Question: The anesthesiologist started an epidural for a Medicaid patient on Nov. 3, then the patient needed a c-section on Nov. 4. Medicaid won't accept the charge for 01967 on Nov. 3 and 01968 on Nov. 4. How do we handle the claim?

Kentucky Subscriber

Answer: Submit a paper claim with a copy of the anesthesia record documenting your physician's service. Include a note such as "delivery spans into day 2" and point out the dates and times for the initial labor and the c-section. Report the correct amount of face-to-face time on Nov. 3 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]). For the actual delivery on Nov. 4, submit the surgical time with +01968 (Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia [List separately in addition to code for primary procedure performed]).

Tip: Check whether the carrier has a policy for reporting c-sections. Some carriers won't pay for both charges (such as Illinois Medicaid, which will only pay both codes if the anesthesiologist uses general anesthesia for the c-section).