You Be the Coder:
Epidural Codes
Published on Mon Apr 01, 2002
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: Our physicians do their own epidurals at delivery. Which of the new CPT codes for these procedures should we use?
Montana Subscriber
Answer: Use 01960 (Anesthesia for; vaginal delivery only) when the patient presents ready for delivery, it is too late for an epidural, the patient cannot be delivered with a local, and a general anesthetic is required.
Code 01961 (Anesthesia for; cesarean delivery only) when the patient is in labor but did not want an epidural for labor, and a cesarean is planned. The code for the epidural with the planned vaginal delivery 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]). If a cesarean (not planned) is then performed, add +01968 (Cesarean delivery following neuraxial labor analgesia/anesthesia [list separately in addition to code for primary procedure]) for that anesthesia.
Billing issues arise with carriers whose computers restrict payment for these procedures to the anesthesiologist but not to the physician who performed the delivery. The codes for epidural in those cases are 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; lumbar, sacral [caudal]) 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 substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; lumbar, sacral [caudal]). Add modifier -47 (Anesthesia by surgeon) to either one of these codes to let the payer know that the ob administered the epidural. A few payers require that you add modifier -47 to the surgical code as well.
CPT 2002 notes in its Anesthesia Guidelines section (page 33): "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."
|
