Anesthesia Coding Alert

Question: One of my anesthesiologists wants to know if anesthesia can bill for an EXIT procedure when the patient is brought in for a C-section. What do you advise? 

New Jersey Subscriber 

Answer: No, your anesthesiologist cannot bill a special code for his work during an EXIT procedure. He 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. 

Explanation: EXIT stands for ex utero intrapartum treatment procedure. It is a specialized surgical delivery procedure used to deliver babies who have airway compression. Newborn babies can have airway compression due to a number of 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 & 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.