Anesthesia Coding Alert

Question: The anesthesiologist places an epidural for labor and delivery. The delivery then turns into a vaginal hysterectomy after an immediate postpartum hemorrhage. The epidural is still in place and is used through the end of the procedure; time is continuous. What should we bill?

Would 01967 plus 58260-59 plus 2 units for emergency be appropriate, and would we reduce the base units for 58260?

Wisconsin Subscriber

Answer: There is a code that describes anesthesia for an urgent hysterectomy following delivery 01962 (Anesthesia for urgent hysterectomy following delivery), and it has the highest base, with a base value of 8 units. Neuraxial labor analgesia for a planned vaginal delivery (01967) has a base value of 5 units. In this case, since 01962 is not an add-on code, you should report 01962 with the total time for both procedures.

Although it does not appear 01967 (Neuraxial labor analgesia/ anesthesia for planned vaginal delivery …) and 58260 (Vaginal hysterectomy, for uterus 250 g or less) are bundled under the National Correct Coding Initiative (NCCI) edits, and there is no national policy for billing obstetric services, 58260 is a surgical code, and you shouldn’t report an anesthesia code with a surgical code, as it will be reported by the surgeon.

Also, depending on the specific insurance company and how your practice calculates labor epidural time, you may want or need to capture documented time for the labor epidural. If the patient’s insurance has an anesthesia obstetric policy, that would take precedence.