Anesthesia Coding Alert

Question: I’m coding for an urgent hysterectomy following vaginal delivery. The anesthesiologist administered an epidural for the vaginal delivery from 01:30 to 09:41 and general anesthesia for the hysterectomy from 09:42 to 12:29. Can I report 01967 and 01962?

New Mexico Subscriber

Answer: The best coding tactic will depend on the insurer. Some insurance companies require a break of at least one hour between anesthesia services to qualify as a separate anesthetic.  Some Medicaid plans will only pay for one service per day (except when you’re reporting add-on codes).  

You could try billing epidural anesthesia (01967) as usual and reporting a general anesthetic (01962-59, 99140) along with the diagnosis related to the reason for urgent hysterectomy. This would mean: 

• 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

• 01962 – Anesthesia for urgent hysterectomy following delivery with modifier 59 (Distinct procedural service) 

• 99140 – Anesthesia complicated by emergency conditions (specify) (List separately in addition to code for primary anesthesia procedure).

The anesthesiologist is not present with the patient for the entire time of the epidural and the insurance company should take that into consideration. You may need to include all related documentation for both services, or be prepared to provide it if requested. If you don’t send the documentation with the first claim and it is denied, you could appeal at that time with copies of records/reports.