Anesthesia Coding Alert

Question: One of our anesthesiologists was in attendance for an expectant mother who was in labor, which ran overnight, into a second day. Then her labor stopped, so the ob-gyn scheduled an unplanned cesarean section. I reported the case with +01968 because of the cesarean procedure that occurred on the second day, but the payer denied the claim. What did I do wrong?

Massachusetts Subscriber

Answer: Some payers will deny +01968 (Anesthesia for cesarean delivery following neuraxial analgesia/ anesthesia [List separately in addition to code for primary procedure performed]), stating you cannot bill it as a stand-alone code. They prefer that you also use 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]), assigning the date the epidural started as the beginning date of service.

To report this multi-day service, list the first day as the date of service for the claim. Report 01967 on the first line of your claim, including the beginning and end times. Then submit +01968 on the next line to report the cesarean section times. This will make it clear to the payer that the epidural performed on the first day was not simply a failed procedure. Coding it this way also removes the impression that you should have also included 01961 (Anesthesia for cesarean delivery only).