Friday, June 10, 2016

Regional Anesthesia CPT code 01967, 01968 and 01969


Topical anesthesia, local, local infiltration and/or metacarpal/digital block, is included in the basic allowance of the surgical procedure performed. No additional reimbursement is provided.

• Nerve Blocks -A nerve block involves the injection of a peripheral nerve into or around a given site. If the anesthesiologist administers the injection or block postoperatively in an area separate from the operating room as part of the anesthesia time, additional time required for the injection may be included in the total number of anesthesia minutes reported. If a qualified anesthesia provider remains with the patient, the time should be reported as continuous rather than discontinuous.

• Spinal, Subarachnoid or Subdural Anesthesia - Spinal, subarachnoid and subdural anesthesia involves the injection of anesthetic or narcotic drugs into the spinal cord. When performed as the primary type of anesthesia, the time required is included in the total anesthesia minutes reported.

• Epidurals -Epidural analgesia involves the administration of a narcotic drug through an epidural catheter. When performed as the primary type of anesthesia, the time required is included in the total anesthesia minutes reported.

• Labor Epidurals -Anesthesia for labor epidurals are time based services and should be billed as total minutes.

o 01967: Vaginal delivery with epidural for pain management. Code may be reported as a single anesthesia service. Depending on the terms of the participating provider agreement, reimbursement may be based on base units plus time units (insertion through delivery) subject to a cap of 7 hours or 420 minutes.

o 01968: Cesarean delivery following failed attempt at vaginal delivery. This is an add-on code and should always be reported with
01967.

o 01969: Cesarean delivery followed by a cesarean hysterectomy after failed planned vaginal delivery. This is an add-on code and should always be reported with 01967.

Note: Florida Blue has incorporated the NCCI Edits into our system. Transesophageal Echocardiography (TEE) Placement and Interpretation is no longer considered for separate reimbursement in addition to payment for the primary anesthesia procedure.

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