Anesthesia Coding Alert

Question: If an ob patient is classified P3, should I report both 01967 and 01968?

Massachusetts Subscriber

Answer: Physical status can help justify anesthesia in some situations and help document the level of risk involved in caring for the patient, but many carriers don't pay additional units for higher physical status modifiers (such as P3, A patient with severe systemic disease; and P4, A patient with severe systemic disease that is a constant threat to life). Adding these physical status modifiers to 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]) is no different than using them with any other case that warrants them.

Because +01968 (Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia [list separately in addition to code for primary procedure performed]) is an add-on code, you can report it only with 01967. You technically have two cases here, so bill time for each by coding them separately. You cannot add physical status modifiers to add-on codes, however, so report P3 only with 01967. Otherwise, it looks as if you're attempting to receive double reimbursement for the patient's higher physical status if the carrier pays additional units for Pcodes.