Anesthesia Coding Alert

Question: We are still attempting to code correctly using the new OB anesthesia codes from CPT 2002. With the new add-on codes, do commercial insurers require documentation of the total base plus time units for each line item, or just the total time of codes 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]) and +01968 (Cesarean delivery following neuraxial labor analgesia/anesthesia [list separately in addition to code for primary procedure]) plus the total time units reported on the claim form?

Nevada Subscriber

Answer: Individual carriers have different guidelines, but most seem to want 01967 and 01968 reported separately on the claim, with the amount of time units associated with each. For example, the California Society of Anesthesiologists says that 01967 is worth five base units plus time and should be used for an epidural during a vaginal delivery. The code also can be used in conjunction with the combining c-section or c-section and hysterectomy codes (01968 and +01969, Cesarean hysterectomy following neuraxial labor analgesia/ anesthesia [list separately in addition to code for primary procedure]). Physicians should complete separate anesthesia records and charge sheets because the codes are new and insurance carriers are not accustomed to seeing labor for c-sections/hysterectomies billed separately. (Sending paper claims for these procedures may be helpful, as well as attaching a copy of the new CPT code descriptors until the carriers update their systems.) In addition, bill each code's beginning-to-ending time separately with no break, and add an explanation in Box 19 of the CMS claim form.

Here's an example of how to document the codes:

 

01967: Beginning time 08:00; ending time 12:00. Actual time spent with patient: 90 minutes. Line 19 explanation: This case ended in a c-section.

01968: Beginning time 12:00; ending time 13:00. Actual time spent with patient: 60 minutes. Line 19 explanation: This case began with a CLE (continuous lumbar epidural) in situ.

You should try to mail both claims together to prevent the carrier from mistakenly believing that only one of the procedures is valid. If an intrathecal opioid analgesia (IOA) is performed during the c-section, it should be listed on the 01968 claim form. You should not bill the emergency code +99140 (Anesthesia complicated by emergency conditions [specify] [list separately in addition to code for primary anesthesia procedure]) for the labor portion because the patient was never required to have anesthesia for labor, but simply desired it. In addition, many carriers do not pay for 99140, although in this case you could argue that a labor epidural cannot reasonably be postponed for half a day and therefore could be considered emergent/urgent. You should bill 99140 to non-government carriers if the c-section is a true emergency (such as fetal distress rather than just failure to progress).