Anesthesia Coding Alert

Answer: The code most often reported for labor and delivery epidurals is 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]). Policies might vary from one hospital or payer to the next, but the anesthesia stop time generally is the time at which the provider removes the patient’s catheter.

 

Important: The first paragraph in the Relative Value Guide (RVG) under Obstetric Services indicates, “Unlike operative anesthesia services, there is no single, widely accepted method of accounting for time for neuraxial labor analgesia.”

 

The result: There isn’t one right answer for this question because it involves many variables. For example, not all locations provide the same type of obstetric services (such as in places where the anesthesia provider will place the catheter and a nurse may remove it). Also, the insurance company may have a policy that defines ending time for labor epidural.  Texas Medicaid indicates to follow time rules for “anesthesia” services, which indicates “Providers should refer to the definition of time in the  CPT® manual in the ‘Anesthesia Guidelines-Time Reporting’ section.” Colorado Medicaid indicates that you should code according to “direct patient contact epidural time.” 

 

Always check with the hospital and payer in question to verify whether their stance on the issue.