December 2001
Volume 65 |
Number 12
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| Code ‘New’:
Changes Improve OB Coding and Billing |
James P. McMichael, M.D.
Committee on Economics
In the October 2000 issue of the ASA NEWSLETTER, L. Charles
Novak, M.D., then Chair of the ASA Committee on Economics, said,
“Chaos reigns in the area of coding, billing and reimbursement
for obstetric anesthesia services.” Is there anyone among
us (who provides anesthesia services to obstetric [OB] patients)
who would dispute that statement?
At the direction of the ASA House of Delegates, the Committee
on Economics has been working for some time on the issue of coding
for OB anesthesia services. Billing and reimbursement are dependent
on accurate and appropriate coding. While anesthesia codes (the
“0XXXX series” in the Current Procedural Terminology™
[CPT] system) have been around for many years, some payers still
do not recognize or use the anesthesia codes but require “surgical”
CPT codes in the reporting of anesthesia services. The Committee
on Economics hopes that all payers will someday accept the rationale
— and resulting simplicity — of the “families”
of anesthesia codes and adopt them.
(A special issue in coding for OB anesthesia services is reporting
the time involved in a neuraxial anesthetic/analgesic for labor,
a subject that is discussed in this issue’s accompanying
article on page 21 by Alexander A. Hannenberg, M.D.)
To correct some persistent problems with the OB codes, the committee
revised some old codes and developed some new codes for OB anesthesia
services with the goal of being able to more accurately and appropriately
report the services provided to parturients. The OB anesthesia
codes will have both new numbers and descriptors that will appear
in CPT 2002 and the 2002 ASA Relative Value Guide (RVG). In some
cases, new base values have been assigned, and these will be published
in the 2002 ASA RVG (values are not published in CPT). As Dr.
Novak outlined, the most important changes are:
• Codes relating to anesthesia services in the peripartum
period will be grouped and numbered into sections in the ASA-RVG
and the CPT book that are specifically set aside for “obstetric
anesthesia.”
• A single code (01967) for neuraxial labor analgesia will
be used for a planned vaginal delivery. Code 01967 is the only
code for which time accounting may be different from the standard
method used for surgical anesthesia.
• For cesarean delivery following neuraxial labor analgesia,
code 01967 becomes a “primary” code, and the operative
delivery will be indicated by an “add-on” code (01968)
with an additional three basic units. Time for the cesarean delivery
will be accounted for as it is for all other surgical anesthesia.
• Other codes will cover the unusual occurrence of hysterectomy
either at the time of cesarean section or following vaginal delivery.
• At the direction of the Clinton administration, the Health
Care Financing Administration (now known as the Centers for Medicare
& Medicaid Services, or CMS) mandated that three new codes
be developed for abortion procedures, tubal ligation and vasectomy.
Table 1 lists the old
code with its corresponding new code and the basic value of the
new code (any change noted in bold). For codes 01968 and 01969,
the new total basic unit value is listed in bold.
Again, in the case of either a cesarean section or a cesarean
hysterectomy following neuraxial labor anesthesia/analgesia, time
for labor will be reported by whatever method is usual in that
locale, and time for the cesarean procedure will be reported as
“usual” operating time.
For reasons that are not clear, the Clinton administration requested
three other new codes relating to “reproductive service,”
abortion procedures, tubal ligations and vasectomies. It was pointed
out to CMS officials that the information they are apparently
interested in is already available in the form of surgical CPT
codes. Nevertheless, the new codes have been established and will
appear in the 2002 publications. The new codes and descriptors
are in Table 2.
Whether confusion results on the part of patients, hospitals
or payers because of the descriptor for 01964 (was the abortion
spontaneous or induced?) remains to be seen. The code number assigned
by CPT for vasectomies is obviously in the wrong section and will
surely be moved to the 009xx section for 2003.
ASA is informing interested parties of the transition to these
new OB codes not only through this article. A member of the Committee
on Economics made a presentation at the Society for Obstetrical
Anesthesia and Perinatology (SOAP) Breakfast Panel at the ASA
Annual Meeting in New Orleans, and similar presentations will
be made at other major OB anesthesia meetings. The Anesthesia
Administrators Assembly, anesthesiology group billing offices,
anesthesia billing software vendors and major payers also are
being informed of the changes.
The purpose of these changes is to allow us to more accurately
and appropriately describe and bill our services. We hope that
payers and other users will adopt the new codes and their corresponding
values quickly, thus minimizing confusion. If there are questions
on this or other coding issues, please contact Sharon Merrick
at the ASA Washington Office <s.merrick@ASAwash.org>.
(Editor’s Note: “Add-on” codes have been available
for use by surgeons for some time; they are relatively new for
anesthesia services. Add-on codes were introduced in the 2001
ASA RVG for anesthesia services for burn excision or debridement.)
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James
P. McMichael, M.D., is a Partner in the Capitol Anesthesiology
Association, Seton Medical Center, Brackenridge Hospital,
Austin, Texas. |
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