Anesthesia Coding Alert

 Question: Currently, when we code for anesthesia, we are only able to report one CPT^® code/ASA code per claim (if more than one procedure is done, we choose the highest base). We are trying to understand how to code the L&D anesthesia for the vaginal delivery, as well as the C-section. When a vaginal delivery converts to a C-section, our lead coder says we would use 01967 followed by add-code +01968. Is this something that anesthesia L&D coders are actively doing and getting paid for?

South Dakota Subscriber

Answer: You would bill 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)) with the start and stop times for the vaginal delivery attempt. 

Then, you would bill +01968 (Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia (List separately in addition to code for primary procedure performed)) with the start and stop times for resulting C-section. You would not use 01961 (Anesthesia for cesarean delivery only) in this scenario, as this is for C-section only.

You should be reimbursed for both 01967 and +01968, although how depends on your contract with the payer. The physician usually will assign a separate diagnosis code for the C-section, such as fetal distress O76 (Abnormality in fetal heart rate and rhythm complicating labor and delivery) or O77 (Other fetal stress complicating labor and delivery).