Anesthesia Coding Alert

Question: I am billing for anesthesia providers who only perform OB anesthesia. I am wondering what the diagnosis code(s) should be when a patient wants an elective primary C-section. Do I also need to attach a Z31 code with the primary code?

Mississippi Subscriber

Answer: You’ll need multiple diagnosis codes in this situation.

First, report the diagnosis that specifies the reason for the planned cesarean section. Two examples include O33.9 (Maternal care for disproportion, unspecified) and O34.21 (Maternal care for scar from previous cesarean delivery), depending on the situation.

Second, report O75.82 (Onset [spontaneous] of labor after 37 completed weeks of gestation but before 39 completed weeks gestation, with delivery by [planned] cesarean section) to represent the delivery by planned C-section. Also include the appropriate code from Z3A (Weeks of gestation…) to represent how far along the pregnancy was.

The final diagnosis should be Z37 (Outcome of delivery…). Remember that this code goes on the mother’s record, but not the baby’s.

Caveat: Although the coding rules indicate a secondary code should be reported to indicate the weeks of gestation, anesthesia providers aren’t always reporting the secondary code. It could be that since the insurance company has the information reported on the OB/GYN’s claim, they are not requiring the duplicate information on the anesthesia claim. Some coders might include Z31 (Encounter for procreative management…), but others might not. Insurers will process the claim either way.