Want to know the coding and billing requirements for anesthesia given during a planned vaginal delivery? You can use CPT code 01967! Labor analgesia has become increasingly popular throughout the world, including the U.S. Around three-quarters (75%) of American women receive neuraxial anesthesia during labor to manage pain.
So, this is a common everyday service for both anesthesiologists and Certified Registered Nurse Anesthetists (CRNAs). For coders, however, it is a completely different story. Many professionals make coding mistakes due to different obstetric anesthesia coding options, scenarios, and techniques. And you know how disastrous this confusion can be.
That’s why today, we will clearly explain what the 01967 CPT code covers and how it differs from other codes, particularly CPT code 01960.
CPT Code 01967 – Description
You can find CPT code 01967 within anesthesia codes for the obstetric procedures category. But what type of pain relief service does this code actually refer to? The 01967 CPT code specifically reports neuraxial anesthesia, a type of local anesthetic injected near the spinal cord during labor.
In simple terms? This pain relief method involves a combination of spinal and epidural blockade. Hence, it guarantees effective pain management during and after childbirth without the common side effects associated with opioids. In short, healthcare providers use this code to notify payers that they have administered neuraxial anesthesia during a planned vaginal delivery.
Scenarios Where CPT Code 01967 is Applicable
Want some guidance on the correct use of CPT code 01967? Here are three detailed examples:
Epidural During Planned Vaginal Delivery
Epidurals are a popular form of neuraxial anesthesia in the U.S. Approximately 70 to 75% of women opt for this type of pain relief while giving birth. So, for the first example, suppose a 29-year-old woman is admitted to the hospital after experiencing contractions.
Since it is a planned vaginal delivery, the patient requests neuraxial anesthesia. Hence, an anesthesiologist places an epidural catheter in the epidural space to provide continuous pain relief during labor. He then uses CPT code 01967 to bill for this service.
Administering Epidural Anesthesia For Labor Pain Management
Did you know that labor induction rates have significantly increased in the U.S. over the last decade? In fact, over 30% of all births were due to the induction of labor in 2020. So, for this scenario, let’s envision a 40-week pregnant woman arriving at a hospital.
After a brief evaluation, her OBGYN decides that labor induction is safer than waiting for it to begin naturally. The patient requests pain relief at the beginning of the induction. Therefore, an anesthesiologist administers and maintains epidural anesthesia throughout labor. He then reports the use of anesthesia during planned vaginal delivery with CPT code 01967.
Administration of Neuraxial Anesthesia
Millions of American women still prefer to give birth naturally. According to the U.S. Centers for Disease Control and Prevention, there were 2.43 million vaginal deliveries compared to 1.16 million cesarean deliveries in 2023. Regardless of the choice, neuraxial analgesia is the gold standard for managing labor pain.
For the final scenario, let’s consider a 23-year-old nulliparous woman. She arrives at an emergency department after spontaneous labor at 38 weeks and asks for pain relief. A CRNA administers a spinal block under the supervision of a provider, providing sufficient pain relief until vaginal delivery a short while later. The billing team, hence, uses CPT code 01967 with the appropriate modifier to request reimbursement for this service.
Applicable Modifiers for CPT Code 01967
The following modifiers are commonly used with this code:
Modifier AA
Did a specialist administer neuraxial anesthesia during planned vaginal delivery? Use modifier AA if it was a qualified anesthesiologist.
Modifier QX
If the epidural was given by a CRNA under a provider’s guidance during planned vaginal delivery, append modifier QX to CPT code 01967.
Modifier QZ
On the other hand, apply modifier QZ to CPT code 01967 if a qualified non-physician, like a CRNA, provided pain relief without the provider’s supervision.
CPT Code 01967 – Billing & Reimbursement Guidelines
Did our scenarios help you understand when to use CPT code 01967? It is equally important for you to understand how to bill this code. For proper reimbursements, follow these steps:
Use CPT Code 01967 to Report Labor Analgesia
The most important thing is to keep this code’s description in your mind. Use this code only when you have administered neuraxial anesthesia (epidural, spinal, or a combination of both) during labor for a planned vaginal delivery.
In simple words? Avoid using this code to bill for pain relief services during cesarean sections. You also cannot use the 01967 code to report anesthesia for vaginal delivery only (there is a different code for that, 01960).
Document this Service Thoroughly
Like many other anesthesia codes, documentation for CPT code 01967 also begins with service duration. This depends on the continuous presence of an anesthesiologist during the entire labor. In addition to this, you must also record the following details for timely payments:
- Delivery (planned vaginal)
- Type of neuraxial anesthesia administered (epidural, spinal, or combined spinal-epidural)
- Anesthesia report (patient status, any potential complications)
Specify the Anesthesia Provider
Specificity is important for avoiding anesthesia denials. Therefore, you must specify who administered this service with the appropriate modifiers. Use modifier AA if an anesthesiologist was involved. Otherwise, append modifier QX or QZ for CRNAs.
Understand Payer-Specific Rules
Before filing a claim for CPT code 01967, you must understand the coverage and billing requirements of each payer to avoid surprises. Remember that some insurance companies may cap the reimbursement for labor neuraxial anesthesia. However, these thresholds vary significantly and entirely depend on the payer.
Conclusion
As you can see, it is quite easy to code for labor neuraxial analgesia. But if you have still missed some details, let us quickly reiterate what this code covers. CPT code 01967, in particular, refers to the administration of neuraxial anesthesia during planned vaginal delivery. This can include a spinal, epidural, or a combined spinal-epidural block.
We have explained all the important details of this obstetric anesthesia code so you don’t confuse it with CPT code 01960. But if some confusion persists, we can help you with your coding. Simply choose our anesthesia billing services for improved results.
