Anesthesia Coding Alert

Question: I am billing for providers who only administer obstetrical anesthesia. What is the best diagnosis code(s) when a patient wants an elective primary C-section? Do I also need to attach a Z code with the primary code?

Illinois Subscriber

Answer: When a patient requests an elective primary C-section, the appropriate diagnosis codes are O75.82 (Onset (spontaneous) of labor after 37 completed weeks of gestation but before 39 completed weeks gestation, with delivery by (planned) cesarean section) followed by the most appropriate code (See Code first to specify the reason for planned cesarean section). Although many obstetric codes indicate to “use additional code to indicate outcome of delivery (Z37.0),” these codes may be appended. However, often the anesthesia provider does not document delivery outcomes and your claim should process without adding a secondary Z code. If you receive a denial for not reporting, make sure you add on the front end. If there is no documentation, Z37.9 (Outcome of delivery, unspecified) should be reported.

Extra tip: Some coders might lean toward reporting O34.211 (Maternal care for low transverse scar from previous cesarean delivery), but this diagnosis is only used when the patient had a previous C-section with a low transverse scar. Diagnosis O75.82 (Onset (spontaneous) of labor after 37 completed weeks of gestation but before 39 completed weeks gestation, with delivery by (planned) cesarean section) applies when the patient wants a first time C-section but there is no medical reason to require it. Submit O34.211 for a repeat C-section along with the code specifying the reason supporting the C-section (O75.82) and the appropriate code from category Z37 (Outcome of delivery).