Anesthesia Coding Alert

Question: A patient came in with fetal demise at 21 weeks. The anesthesiologist placed an epidural for her labor, and she delivered the baby. An hour later she returned to the operating room because of a retained placenta. The same anesthesiologist used the previously placed epidural to administer a bolus for the dilation and curettage. How should I code this case?


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Answer: Report the initial encounter with 01965 (Anesthesia for incomplete or missed abortion procedures) and the anesthesiologist's time.

Because the physician used the previously placed epidural catheter when the patient returned to the operating room, report 01965 again, along with modifier 78 (Return to the operating room for a related procedure during the postoperative period) and the physician's time spent on the return procedure.

Submit the claim with diagnoses 632 (Missed abortion) and either 667.0x (Retained placenta without hemorrhage) or 667.1x (Retained portions of placenta or membranes, without hemorrhage). If you can't determine whether the patient hemorrhaged, report 667.0x.

Use discontinuous time to report the anesthesiologist's time. Note the start and final stop times of the encounter, but only bill for the time he actually spent with the patient.