ARCHIVED


 

Medical Policy

Policy Num:       12.002.001
Policy Name:     Regional Anesthesia in Vaginal Birth
Policy ID:          [12.002.001][Ac L M P ][0.00.00]

Last Review:      March 31, 2019
Next Review:     Archived
Issue:                   3:2019

Related Policies:

None

Regional Anesthesia in Vaginal Birth

Popultation Reference No. Populations Interventions Comparators Outcomes
1 Individuals:
  • in need of analgesia/anesthesia for vaginal birth
 Interventions of interest are:
  • Epidural block
 Comparators of interest are:
  • local infiltration/no analgesia

Relevant outcomes include:

  • morbidity

  • well being
2 Individuals:
  • in need of analgesia/anesthesia for vaginal birth
 Interventions of interest are:
  • Continuos epidural
 Comparators of interest are:
  • local infiltration/no analgesia

Relevant outcomes include:

  •  morbidity

  • well being

Summary

Regional anesthesia is one that is selectively applied to a specific region of the body. Under the term of regional anesthesia is included:  

ü Spinal: It is produced by the injection of an anesthetic agent, under the spinal cord membrane.  

ü Epidural (Blocking): The anesthesia produced by the injection of an anesthetic agent between the vertebral spines and below the flavo ligament in the extradural space.

 ü Analgesia / neuraxial anesthesia: epidural anesthesia continues through a catheter into the epidural space. This modality is started during labor and continues until delivery or cesarean section. Normally the catheter is not changed in the case of caesarean section but if a higher concentration of the anesthetic agent is added.

 ü Nerve block: Infiltration around the nerve at the exit of the spine. (For example, a nerve plexus or an individual peripheral nerve can be blocked). 

ü Local infiltration: Infiltration in the area where the nerve ends.

Objective

Regional anesthesia is one that is selectively applied to a specific region of the body; between them; Spinal, Epidural (Blocking), Analgesia / neuraxial anesthesia and Nerve block.

Policy Statements

Local infiltration and pudendal blockade are considered part of the management of labor and are included in the code 59410 for vaginal delivery.  

Neuraxial analgesia (continuous epidural) is considered for payment in the following situations:  

ü Fetal causes (eg, fetal distress, cord prolapses, placental abruption)

ü Maternal causes (eg, maternal cardiovascular disease, maternal respiratory disease, history of malignant hyperthermia, parturient with a high spinal cord injury, when a possible difficulty in intubation is anticipated).

ü Breech fetal presentation

ü Elective application of "forceps"

Policy Guidelines

N/A

Benefit Application

BlueCard/National Account Issues

N/A

Background

N/A

Regulatory Status

N/A

Rationale

Population Reference No. 1 Policy Statement

Individual in need for anesthesia for vaginal birth with epidural block

Population Reference No. 1 Policy Statement [X ] MedicallyNecessary [ ] Investigational [ ] Not Medically Necessary

Population Reference No. 2 Policy Statement

Population: Individual in need for anesthesia for vaginal birth with continuous epidural epidural

Population Reference No. 2 Policy Statement [X ] MedicallyNecessary [ ] Investigational [ ] Not Medically Necessary

Supplemental Information

N/A

Practice Guidelines and Position Statements

N/A

Medicare National Coverage

N/A

References

1.    Current Procedural Terminology (CPT) 2016, American Medical Association.

 

2.    American College of Obstetricians and Gynecologist; Obstetric Analgesia and Anesthesia; Practice Bulletin No. 36, July 2002, Reaffirmed 2013.

Codes

Codes Number Description

 

01960–01969

Obstetric anesthesia code range 

 

59410

Vaginal delivery only (with or without episiotomy and or forceps)including post partum care

 

V22.0

Supervision of normal first pregnancy

 

V22.1

Supervision of other normal pregnancy

 

V22.2

Pregnant state, incidental

 

V23.0

Pregnancy of history of infertility

 

V23.1

Pregnancy with history of trophoblastic disease

 

V23.2

Pregnancy with history of abortion

 

V23.3

Grand multiparity

 

V23.41

Pregnancy with history of labor pre-term

 

V23.49

Pregnancy with other poor obstetric history

 

V23.5

Pregnancy  with other [poor reproductive history

 

V23.7

Insufficient prenatal care

 

V23.81

Elderly primigravida

 

V23.82

Elderly multigravida

 

V23.83

Young primigravida

 

V23.84

Young multigravida

 

V23.85

Pregnancy resulting from assisted reproductive technology

 

V23.86

Pregnancy with history of in utero procedure during previous pregnancy

 

V23.89

Other high risk pregnancy

 

V23.9

Unspecified high risk pregnancy

ICD-10-CM(effective 10/1/15)

 

 

 

Z34.00

Encounter for supervision of normal first pregnancy, unspecified trimester

 

Z34.80

Encounter for supervision of other normal pregnancy, unspecified trimester

 

Z34.90

Encounter for supervision of normal pregnancy, unspecified, unspecified trimester

 

Z33.1

Pregnant state, incidental

 

O09.00

Supervision of pregnancy with history of infertility, unspecified trimester

 

O09.10

Supervision of pregnancy with history of ectopic or molar pregnancy, unspecified trimester

 

O09.291

Supervision of pregnancy with other poor reproductive or obstetric history, first trimester

 

O09.40

Supervision of pregnancy with grand multiparity, unspecified trimester

 

O09.211

Supervision of pregnancy with history of pre-term labor, first trimester

 

O09.291

Supervision of pregnancy with other poor reproductive or obstetric history, first trimester

 

O09.291

Supervision of pregnancy with other poor reproductive or obstetric history, first trimester

 

O09.30

Supervision of pregnancy with insufficient antenatal care, unspecified trimester

 

O09.511

Supervision of elderly primigravida, first trimester

 

O09.521

Supervision of elderly multigravida, first trimester

 

O09.611

Supervision of young primigravida, first trimester

 

O09.621

Supervision of young multigravida, first trimester

 

O09.819

Supervision of pregnancy resulting from assisted reproductive technology, unspecified trimester

 

O09.821

Supervision of pregnancy with history of in utero procedure during previous pregnancy, first trimester

 

O09.822

Supervision of pregnancy with history of in utero procedure during previous pregnancy, second trimester

 

O09.823

Supervision of pregnancy with history of in utero procedure during previous pregnancy, third trimester

 

O09.829

Supervision of pregnancy with history of in utero procedure during previous pregnancy, unspecified trimester

 

O09.891

Supervision of other high risk pregnancies, first trimester

 

O09.892

Supervision of other high risk pregnancies, second trimester

 

O09.893

Supervision of other high risk pregnancies, third trimester

 

O09.899

Supervision of other high risk pregnancies, unspecified trimester

 

O09.90

Supervision of high risk pregnancy, unspecified, unspecified trimester

 

O09.91

Supervision of high risk pregnancy, unspecified, first trimester

 

O09.92

Supervision of high risk pregnancy, unspecified, second trimester

 

O09.93

Supervision of high risk pregnancy, unspecified, third trimester

Appplicable Modifiers

Policy History

Date Action Description

03/31/2019

Annual Review

No changes.  New Format

05/10/2016

 Policy archived

 

09/18/2014

 

References

11/28/2011

 

Added ICD-10

04/22/2009

 

ICES

07/30/2008

 

 

08/09/2006

 

 

12/22/2004

 

 

04/18/2002

 

 

04/26/2000