Start, Stop and Total Anesthesia Time
Claims billing for more than 40 units of time (10 hours) require that an anesthesia report be attached to the claim. The anesthesia report must include anesthesia start, stop and total times.
CPT-4 Code 01967 Billing Requirements:
For CPT-4 code 01967 (neuraxial labor analgesia/anesthesia for planned vaginal delivery [includes any repeat subarachnoid needle placement and drug injection and/or any necessary replacement of an epidural catheter during labor]), all claims of 20 units or more require that an anesthesia report be attached.
Note: Claims for 19 units or less for code 01967 do not require detailed documentation on the claim form or an attachment
“Time in Attendance” With the Patient
If billing for obstetrical regional anesthesia (CPT-4 code 01967), in addition to the documentation requirements noted above, providers also must document “time in attendance” on the attached anesthesia report. Claims without such documentation will be denied. Only time
in attendance with the patient may be billed.
“Time in attendance” is time when the anesthesiologist or Certified Registered Nurse Anesthetist (CRNA) monitors the patient receiving neuraxial labor analgesia, and the anesthesiologist or CRNA is readily and immediately available in the labor or delivery suite. If the actual
time in attendance is less than the total quantity billed (in either the Service Units or Days or Units box), the claim will be reimbursed for
the time in attendance with the patient. If two or more patients receive neuraxial analgesia concurrently, no more than four total time units per hour may be billed and must be apportioned among the claims, including claims to other insurance carriers.