Anesthesia Coding Alert

Question: A patient came in for a scheduled cesarean section and was given a spinal. Should I use 01991, or should I follow the advice of a colleague and use 01961?

AAPC Forum Participant

Answer: In this situation, 01991(Anesthesia for diagnostic or therapeutic nerve blocks and injections (when block or injection is performed by a different physician or other qualified health care professional); other than the prone position) would not be the correct code. Instead, you should take your colleague’s advice and use 01961 (Anesthesia for cesarean delivery only), assuming that the spinal and cesarean are uncomplicated.

Here’s why: Aside from the fact that the code descriptor for 01961 specifically mentions the anesthesia for cesarean delivery, the anesthesia code crosswalks to surgical code 59514 (Cesarean delivery only). This is supported by CPT^® Assistant Volume 11, Issue 12 (2001), which notes “01961 would … be appropriate to use in the case of a planned c-section.” The article goes on to note that “the type of anesthesia care rendered is not a factor. It could be general, epidural, or spinal.”

 Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC