Anesthesia Coding Alert

Question: We have one anesthesia record for the delivery of twins that says the anesthesiologist performed anesthesia for two procedures: a vaginal delivery for Baby A and an emergency cesarean section for Baby B. How should I code his services?


Michigan Subscriber

 
Answer: For the procedure itself, code as a vaginal delivery that changed to cesarean section. Report 01967 (Neuraxial labor analgesia/anesthesia for planned vaginal delivery [this includes any repeat subarachnoid needle placement and drug injection and/or necessary replacement of an epidural catheter during labor]) with add-on code +01968 (Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia [list separately in addition to code for primary procedure performed]).

Begin your diagnosis coding with 651.0x (Twin pregnancy) and expand to include the reason for the c-section (such as 768.3, Fetal distress first noted during labor and delivery, in liveborn infant) for fetal distress.

Depending on the mother's age, you might also include a diagnosis such as 659.5x (Elderly primigravida), 659.6x (Elderly multigravida), or 659.8x (Other specified indications for care or intervention related to labor and delivery) for a mother younger than 16 years of age. 

As long as you match the diagnosis and procedure codes correctly, your claim should be fine. If the insurance company questions the claim, be prepared to send your report for both the epidural and c-section services.