Coding for Neuraxial Labor Analgesia/Anesthesia

Posted by on February 14, 2014 6:25 am

Neuraxial Labor Analgesia/Anesthesia is provided to ease a woman’s pain during labor and delivery and is administered by an anesthesiologist and/or CRNA. Anesthesiology medical coding for obstetrical procedures involves the base units, time units and modifying units. Let’s see how to report this service using CPT codes.

When the neuraxial labor analgesia/anesthesia is administered by an anesthesiologist or CRNA, the anesthesia code 01967 should be reported along with an appropriate modifier from the following list.

Modifiers Used by Anesthesiologists

  • AA: Anesthesia services performed personally by anesthesiologist
  • AD: Medical supervision by a physician (anesthesiologist); more than four concurrent anesthesia procedures
  • QK: Medical direction (supervision) of two, three or four concurrent anesthesia procedures
  • QY: Anesthesiologist medically directs one CRNA

Modifiers Used By CRNAs

  • QX: CRNA service with medical direction (supervision) by a physician
  • QZ: CRNA service without medical direction (supervision) by a physician

Anesthesia time should also be reported along with this code, and the time units are calculated in 30-minute increments.

For a cesarean delivery or cesarean hysterectomy following neuraxial labor analgesia, report codes 01968 or 01969 appropriately. Anesthesia time and modifiers are required in this case.

Use code 01996 for daily management of epidural or subarachnoid drug administration; anesthesia time and modifiers are not required for this code.

Here are the CPT codes that can be used to report neuraxial labor analgesia/anesthesia along with the code description, basic values and guidelines.

Code Description Basic Values Guidelines
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)

5

For each 30-minute increment of time, one unit is allowed

+ 01968

Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia

(Use 01968 in conjunction with code 01967)

3

For each 15-minute increment of time, one unit is allowed

+01969

Anesthesia for cesarean hysterectomy following neuraxial labor analgesia/anesthesia

(Use 01969 in conjunction with code 01967)

5

For each 15-minute increment of time, one unit is allowed

01996

Daily management of epidural, not to include the day that the catheter is placed

N/A

No reimbursement can be received for the day on which the catheter is placed. Maximum three visits are allowed. Additional visits are reviewed for medical necessity.

62310-59 OR 62311-59

Single epidural injection for post-operative pain management

9
OR
8

Separate reimbursement can be received for post-operative injections given for pain management.

62318
OR
62319

Placement of epidural catheter for post-operative pain management

10
OR
9

9 or ten additional base units are allowed for epidural catheter placement for post-operative pain management. These codes should be billed only if the relevant procedure is performed under general anesthesia followed by catheter placement. They should not be billed in conjunction with any of the ASA codes mentioned above. Though modifier-59 is required for filing these codes, anesthesia modifiers and time are not needed.

Sometimes, the neuraxial labor analgesia/anesthesia is provided by one practitioner and the administration of anesthesia during cesarean delivery or cesarean hysterectomy is by another practitioner. In such cases, the correct code should be reported along with the appropriate modifier. The anesthesiologists can receive reimbursement for medical direction.

  • Suppose the neuraxial labor analgesia/anesthesia is personally performed by the anesthesiologist and the anesthesia for the cesarean delivery is provided by a CRNA while the anesthesiologist supervises (medically directs two CRNAs). The CRNA is employed by the practice same as that of the anesthesiologist. The following should be the codes.

    01967-AA
    01968-QK
    01968-QX

  • When the CRNA is not employed by the same practice as the anesthesiologist, the coding will be different. Take the case of neuraxial labor analgesia/anesthesia being personally performed by the anesthesiologist, and the anesthesia for cesarean delivery is provided by the CRNA while the anesthesiologist supervises (medically directs one CRNA). The coding would be:

    01967-AA
    01968-QY

  • In this case, the CRNA would file a separate claim, reporting the anesthesia administered for cesarean delivery only. Some insurers allow the CRNA in a case such as the above to report the “add-on” code 01968-QX as a standalone code on a separate claim without the code 01967. This policy change is applicable also to the “add-on” code 01969, which can be reported as a standalone code on a separate claim if applicable.

    CRNAs cannot use the code 01961-QX to report the administration of anesthesia during the cesarean delivery in the above mentioned instance.

  • In a case where the neuraxial labor analgesia/anesthesia is performed by a CRNA and the anesthesia for the cesarean delivery is performed by the supervising anesthesiologist (the CRNA is employed by the same practice as the anesthesiologist), medical direction is for one CRNA and the coding is as follows:

    01967-QX
    01967-QY
    01968-AA

Include only the anesthesia time for the labor on the line item for the neuraxial analgesia/anesthesia (01967). For the cesarean delivery (01968), include only the anesthesia time for the delivery on the line item.

As each insurance carrier would have individual guidelines for anesthesia billing and payment, it is prudent to seek help from an expert in anesthesia coding to report anesthesia services delivered for obstetrical procedures. Partnering with a professional medical billing and coding company having expertise in anesthesiology medical billing is a good option.

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Meghann Kiernan

Solutions Manager: Medical Billing, Coding and Collections at Outsource Strategies International
Meghann joined the MOS team as a solutions manager in February 2013. With formal education in medical billing and coding, as well as years of hands on experience in the full revenue cycle, Meghann brings a wealth of well-rounded knowledge that will benefit MOS clients. Meghann resides in New Jersey.