Ob-Gyn Coding Alert

Question: Our ob/gyn performs his own epidurals for deliveries. How should I code for these: 62319 or 01967?

Texas Subscriber

Answer: Code 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]) describes an epidural with a planned vaginal delivery. The problem, however, is that this code is intended to be reported by an anesthesiologist, not the physician who is also doing the delivery, and there may be some payers who have this restriction loaded in their computer.

CPT guidelines are specific about this as well. CPT 2002 (page 33) states, "To report regional or general anesthesia provided by a physician also performing the services for which the anesthesia is being provided, see modifier '-47,' Anesthesia by Surgeon, in Appendix A." CPT Assistant (May 1977) also clarified that modifier -47 should be appended to the surgical code, and you should report a second code for anesthetic injection instead of the anesthesia codes. In this case, you would add modifier -47 to the global or delivery code (59400, Routine obstetric care including antepartum care, vaginal delivery [with or without episiotomy, and/or forceps] and postpartum care; 59409, Vaginal delivery only [with or without episiotomy and/or forceps]; or 59410, including postpartum care), and you would also report either 62311 (Injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; cervical or thoracic) or 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 substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; lumbar, sacral [caudal]) for the epidural.