Anesthesia Coding Education: Combined Spinal Epidural

Question: Our anesthesiologists sometimes mark our C-section tickets as “combined spinal epidural,” but our billing system will only allow us to choose epidural or spinal. Where can I find information about spinal epidurals and how to correctly code them? Answer: From a coding perspective, whether your physician used spinal or epidural anesthesia doesn’t matter as long [...] Related articles:

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Question: Our anesthesiologists sometimes mark our C-section tickets as “combined spinal epidural,” but our billing system will only allow us to choose epidural or spinal. Where can I find information about spinal epidurals and how to correctly code them?

Answer: From a coding perspective, whether your physician used spinal or epidural anesthesia doesn’t matter as long as you report the correct obstetrics code. Base your anesthesia code on the case specifics:

• 01961 (Anesthesia for cesarean deliver only) for a straight c-section instead of converting from labor to a csection

• 01967 (Neuraxial labor analgesia/anesthesia for planned vaginal deliver [this includes any repeat subarachnoid needle placement and drug injection and/or any necessary replacement of an epidural catheter during labor]) for a standard labor and vaginal delivery

• +01968 (Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia [List separately in addition to code for primary procedure performed]) for a planned vaginal delivery that changes to a cesarean section.