Ob-Gyn Coding Alert

Question: How should I code intrathecal injections done during delivery? I’m confused by anesthesia by ob doctors.

Mississippi Subscriber

Answer: You should use the same codes you would use for either the subarachnoid or the epidural space:

• 62311 (Injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substances[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; lumbar, sacral [caudal]) for a single injection, and
• 62319 (Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substances[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; lumbar, sacral [caudal]) for continuous infusion.

Heads-up: You should append modifier 47 (Anesthesia by surgeon) to the delivery/global code (for instance, 59400-59410) and modifier 51 (Multiple procedures) to the injection code (62311 or 62319).

To understand regional anesthesia for obstetrics, you should get a handle on some of the terms. An intrathecal injection is one into the spinal canal, more specifically into the sub-arachnoid space so that it reaches the cerebral spinal fluid. You’ll find that several anatomic layers cover the spinal cord. The “space” just above the cord and the cerebral spinal fluid is called the subarachnoid or subdural space. The area adjacent to or above this is the epidural space.

Rule of thumb: Whenever the physician punctures the “dura” (lining of the spinal cord), the instillation of anesthetic carries the risk of getting too high and interfering with maternal respiration. Epidural anesthesia is placed in contact with but not entering the dura.

Instillation of intrathecal medication is a new technique, but ob-gyns perform this service in much the same way. A very small dose of an opiate (usually morphine) or an opiate mixed with a local anesthetic can be placed in the same location using the same technique as is done with the epidural. The risks of toxic effects of local anesthetics and the risk of getting  “too high” are minimal because of the small dose necessary.