Wiki 99140 and C-sections

[kenbeckman]

Would like any thoughts on this subject

I am seeing a claim for add-on code 99140 for almost every non-scheduled C-section. I understand when a true emergency (eclamptic seizure, footling, etc.) arises that this code would be appropriate. However, every woman who fails a trial of labor and the OB decides to do a C-section ends up with the initial anesthesia code 01967, plus the add-on code 01968 plus this add-on code 99140.

The problem is that CPT has a rather odd definition of 'emergency' - exists when a delay in treatment of the patient would lead to a significant increase in the threat to life or body part.

Many large hospitals have full time anesthesiologists in their OB unit and they are already getting paid for upgrading the neuraxial labor anesthesia to a C-section. Should they also get paid for 99140 simply because the C/S was not planned and therefore constitutes an 'emergency'?

 

[Michele Hannon]

99140 use is indicated for a true medical emergency where there is threat to life or limb.
OB emergencies include: non-reassuring fetal heart monitor, prolapsed cord, placental abruption or previa, eclampsia, etc.
You are correct, a failed trial of labor (failure to progress, unfavorable cervix, cephalo-pelvic disproportion) does not constitute the use of 99140.
The pre-op/post-op diagnosis will drive the payment for 99140, not the time of day or night the procedure was performed.