Anesthesia Coding Alert

Question: A patient attempted a VBAC delivery but it failed due to fetal distress. She delivered by C-section. The OB/GYN performed a hysterectomy during the C-section. How should I code this delivery and diagnoses?

Wisconsin Subscriber

Answer: The situation you describe is not uncommon; many women initially have a labor epidural but progress to a cesarean section during labor for a variety of reasons (failure to progress, elevated blood pressure, a drop in the baby’s heart rate, etc.).

The labor and delivery add-on codes help resolve these situations by giving anesthesia providers a way to report services more accurately even if reimbursement stays the same.

For example, the code for anesthesia during a cesarean hysterectomy, 01963 (Anesthesia for cesarean hysterectomy without any labor analgesia/anesthesia care), doesn’t accurately report the situation if the patient began with a labor epidural. You also have the option of coding a hysterectomy at the time of a C-section following a labor epidural with01967 (Neuraxial labor analgesia/anesthesia for planned vaginal delivery (this includes any repeat subarachnoid needle placement and drug injection and/or any necessary replacement of an epidural catheter during labor))  and +01969 (Anesthesia for cesarean hysterectomy following neuraxial labor analgesia/anesthesia (List separately in addition to code for primary procedure performed)). Both options for reporting the hysterectomy equal 10 units (10 units for 01963, and 5 units each for 01967 and 01969), but the claim is clearer and the anesthesiologist receives the appropriate reimbursement for his services if you use the two codes together.

In terms of time units, you should report the total time for all work associated with each procedure or as instructed if payers have a specific time reporting requirement.

Diagnosis code: Depending on the supporting documentation, you should be able to submit diagnosis O34.211 (Maternal care for low transverse scar from previous cesarean delivery) to represent the previous c-section (if the scar from the previous c-section is visible). For fetal distress, report O77.9 (Labor and delivery complicated by fetal stress, unspecified).