Anesthesia Coding Alert

Question: An obstetrics patient had an epidural beginning at 1438 on September 2. She went into surgery at 1845 (the same day) with another anesthesiologist from our group in attendance. He administered MAC with a start time of 1845 and end time of 2130. Baby A was born at 1920 and Baby B was born at 2001. We would normally bill a flat fee for the epidural using 62319, but this is a different case. How should we handle the coding?

Mississippi Subscriber

Answer: This is a complicated question because the situation includes so many “if’s.” Here are factors you should consider before submitting the claim.

• The ASA (American Society of Anesthesiologists) does not support reporting 62319 (Injection[s], including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, includes contrast for localization when performed, epidural or subarachnoid; lumbar or sacral [caudal]) for insertion of an epidural catheter for a laboring patient. However, there are some anesthesia providers who choose to report this method when it is the only anesthetic service provided to the laboring patient (such as when labor nurses will manage the catheter, monitor the patient and remove the catheter after delivery).
• If the situation above is the case, report the first procedure as you normally do with 62319 to indicate placement of the indwelling catheter. You’ll receive a flat fee for the service, and time is not a factor. You would report the second case with the appropriate time according to the anesthesia record (18:45 to 21:30) and the appropriate anesthesia code (01960 for a vaginal delivery or 01961 for a cesarean delivery).
• If the payer requires a monitored anesthesia care modifier, append it to the second claim after modifier 59 (Distinct procedural service) to indicate this was a distinct service.
• Reporting code 01960 (Anesthesia for vaginal delivery only) may be questionable, however, as the intent of the epidural catheter is to provide “labor analgesia/anesthesia care” (See comments below the code in CPT®).

Best bet: Contact the insurance carrier or check for an obstetric policy that may require you to 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]). If this is the case, you would only report 01967 since the code includes all related analgesia/anesthesia services.