Anesthesia Coding Alert
Labor Epidural with Two Physicians
Question: A physician started a labor epidural that ran from 5 p.m. to 1 a.m. The baby didn't deliver during this time. At 3 p.m., another anesthesiologist restarted the epidural through the same catheter that was placed the previous day. How should this be billed?
Virginia Subscriber
Answer: Your best option is to bill discontinuous time. The first anesthesiologist can bill for placement of the epidural (62310, Injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epiduro-graphy], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; cervical or thoracic; or 62311, lumbar, sacral [caudal]) and the time involved with it.
The second anesthesiologist cannot bill for placement because the same catheter was used, but he or she can charge for the time involved with restarting the epidural. Because no code exists for this procedure, the second anesthesiologist should bill either 62310 or 62311 (whichever the first physician reported) with modifier -52 (Reduced services) and include documentation that he or she monitored the catheter instead of placing it. If the physicians are from the same group, another option is to bill only for the first physician. With the changes in ob anesthesia codes this year, you can change the physician's care of a laboring patient to a cesarean section and bill the base amounts for both.
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