Mountain State Medical Policy Bulletin
Section: Anesthesia
Number: A-5
Topic: Obstetrical Anesthesia
Effective Date: August 1, 2005
Issued Date: August 1, 2005
Date Last Reviewed: 09/2005

General Policy Guidelines

Indications and Limitations of Coverage

Anesthesia related to obstetrical care may include any of the following procedures:

  • 01960 - anesthesia for vaginal delivery only
  • 01961 - anesthesia for cesarean delivery only
  • 01962 - anesthesia for urgent hysterectomy following delivery
  • 01967 - epidural insertion for labor 
  • 01967 - epidural insertion for labor and vaginal delivery
  • 01968 - anesthesia for cesarean delivery following labor analgesia 
  • 01969 - anesthesia for cesarean hysterectomy following labor analgesia 
  • 62273, 62281, 62282, 62311 - injections/nerve blocks (no catheter insertion) 

Code 01967 should be reported for epidural anesthesia care provided either 1) during labor only, or 2) during labor and vaginal delivery. Total time reported should reflect actual time in personal attendance (i.e., "face time") with the patient. Payment for code 01967 will be based on the appropriate number of base units (BU) and total time units (TU) in attendance with the patient, either during labor only or during labor with vaginal delivery.

When procedure code 01967 is reported in conjunction with either 01968 or 01969, the base units and time units for each code should be reimbursed. Time units reported should reflect actual time in personal attendance ("face time") with the patient. The appropriate anesthesia modifier should be reported with each code to determine the level of reimbursement for each code, i.e., 100% or 50%. See reporting and reimbursement examples below.

The anesthesiologist personally performs the labor epidural and the cesarean section:

Line 1 
01967AA  -- BU + TU x conversion factor 

Line 2 
01968AA  -- BU + TU x conversion factor 

The anesthesiologist personally performs the labor epidural and medically directs a CRNA (nonemployee) during the cesarean section:

Line 1 
01967AA  -- BU + TU x conversion factor   

Line 2 
01968QK  -- BU + TU x conversion factor  x 50%  

NOTE:
Procedure codes 01960, 01961, and 01962 should not be reported in conjunction with 01967.

In addition, daily management of epidural drug administration (01996) is also eligible for separate payment after the day on which an epidural catheter is inserted. Daily management reported on the same day as the catheter insertion is not covered. A participating, preferred, or network provider cannot bill the member for daily management on the same day as the catheter insertion.

NOTE:
Refer to Mountain State Medical Policy Bulletin A-2 when the anesthesia and delivery are performed by the same physician.

Procedure Codes

019600196101962019670196801969
0199662273622816228262311 

Traditional Guidelines

Refer to General Policy Guidelines

FEP Guidelines

Refer to General Policy Guidelines

PPO Guidelines

Refer to General Policy Guidelines

Managed Care POS Guidelines

Refer to General Policy Guidelines

Publications

PRN References

08/2003, Blue Shield pays separately for obstetrical anesthesia and related services
02/2004, How to report epidural anesthesia provided during labor and vaginal delivery
06/2005, How to report epidural anesthesia provided during labor and cesarean delivery

References

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Table Attachment

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Glossary




This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Medical policies are designed to supplement the terms of a member's contract. The member's contract defines the benefits available; therefore, medical policies should not be construed as overriding specific contract language. In the event of conflict, the contract shall govern.

Medical policies do not constitute medical advice, nor the practice of medicine. Rather, such policies are intended only to establish general guidelines for coverage and reimbursement under Mountain State Blue Cross Blue Shield plans. Application of a medical policy to determine coverage in an individual instance is not intended and shall not be construed to supercede the professional judgment of a treating provider. In all situations, the treating provider must use his/her professional judgment to provide care he/she believes to be in the best interest of the patient, and the provider and patient remain responsible for all treatment decisions.

Mountain State Blue Cross Blue Shield (MSBCBS) retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of MSBCBS. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.