Anesthesia Coders: Know How to Report for Multiple Procedures During Obstetric Cases

Obstetrical cases don’t always go as planned, so make sure you’re ready to report the correct anesthesia CPT® codes for these labor and delivery variations.

Handle Labor, C-Section, and Tubal Ligation Coding

Question: What is the proper coding when a patient has anesthesia for labor that results in a cesarean section with tubal ligation at the same operative session?

Answer: For multiple procedures at the same anesthetic session, you should code for the most complex anesthetic, according to the October 2014 CPT® Assistant. In the case described, you should report 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)) and +01968 (Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia …).

You should not separately report 00851 (Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; tubal ligation/transection), CPT® Assistant states.

You also should report the total time for all procedures, applying local standards and payer rules.

Watch out: Some payers have specific guidelines for coding planned vaginal deliveries that turn into C-sections. Some may even instruct you to report +01968 as a primary code. Check with your payers for their written policies on coding anesthesia for obstetric cases.

Add Hysterectomy to Your Coding Scenario

Question: The anesthesiologist started a labor epidural but the patient required a C-section with hysterectomy after complications. How should I report the anesthesia?

Answer: The hysterectomy will change your coding, so watching for that procedure is important. Because the patient started with a labor epidural, report 01967 and then look for the appropriate add-on code, +01969 (Anesthesia for cesarean hysterectomy following neuraxial labor analgesia/anesthesia …).

Note that CPT® also includes standalone code 01963 (Anesthesia for cesarean hysterectomy without any labor analgesia/anesthesia care). That code descriptor specifically excludes labor analgesia/anesthesia care, so it is not the most appropriate code for cases where the patient starts with a labor epidural.

Need an Extra Code for Episiotomy MAC?

Question: The anesthesiologist provided an epidural for a vaginal delivery followed at the same encounter by monitored anesthesia care (MAC) for episiotomy repair. Should we report two codes?

Answer: Apply the same rules from the previous questions to this question. You should code for the more complicated procedure and report the total time so all services are accounted for.

In this case, you’ll again report 01967. For the time, count from epidural placement through the hand-off to post-op care after the episiotomy.

What About You?

What obstetric cases have you seen that challenged your anesthesia coding skills?

 

About 

Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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1 Comments For This Post

  1. Amruta Patil Says:

    This is an excellent piece of information. Although I’ve always felt that medical coding can be a significant hazard for if not done correctly. What are your opinions?

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