Anesthesia Coding Alert

Question: One of my anesthesiologists is asking whether we can bill for an EXIT procedure when the patient is brought in for a C-section. Is that allowed?

New Jersey Subscriber

Answer: No, your anesthesiologist cannot bill a special code for their work during an ex utero intrapartum treatment (EXIT) procedure. They should report 01961 (Anesthesia for cesarean delivery only) plus the applicable time units plus +99140 (Anesthesia complicated by emergency conditions (specify) (List separately in addition to code for primary anesthesia procedure)). Anesthesia providers are paid based on time, and the EXIT procedure likely extended the face-to-face time your anesthesiologist spent with the patient. Documentation of the procedure will help justify the higher-than-normal time for the delivery.

The procedure: EXIT is a specialized surgical delivery procedure used to deliver babies who have airway compression. Newborn babies can have airway compression due to several rare congenital disorders, including bronchopulmonary sequestration, a mouth or neck tumor such as teratoma, or a lung or pleural tumor such as pleuropulmonary blastoma. Airway compression discovered at birth is a medical emergency. In many cases, however, the airway compression is discovered during prenatal ultrasound exams, permitting time to plan a safe delivery using the EXIT procedure or other means.

The EXIT is an extension of a standard classical Cesarean section. The baby is partially delivered through an opening in the mother’s abdomen and uterus but remains attached to the placenta by its umbilical cord. A pediatric head and neck surgeon establishes an airway so the fetus can breathe. Once the EXIT is complete, the umbilical cord is clamped and cut so the infant can be fully delivered.