Anesthesia Coding Alert

Question: Our carrier is denying claims when the obstetrician performs a sterilization the same day as a vaginal delivery. Can our anesthesiologist be paid for both procedures?


Nebraska Subscriber
Answer: The answer depends on the timing of both procedures. If the obstetrician performs the sterilization immediately following delivery, you-ll only code for the delivery (01967, 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]) because it's the higher-base service.

Although you only report one code, remember to bill for all time units associated with both the delivery and sterilization.

If the obstetrician performs the sterilization several hours after the delivery, you can report both services for the anesthesiologist. Report 01967 for the delivery, and then 00851 (Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; tubal ligation/transection) for the sterilization. Append modifier 59 (Distinct procedural service) to indicate that these are two separate procedures, and submit diagnosis V25.2 (Encounter for contraceptive management, sterilization).

You Be the Coder and Reader Questions were reviewed by Cindy Smith, CPC, of Professional Healthcare Billing Services in Charleston, W. Va.