Wiki Anesthesia adminstered for two c/s

[lovetocode]

Pt was brought to the OR and spinal is placed for cesarean delivery due to worseing HTN in pregnancy, BDM, poor compliance with care, and fetal breech position. Before preparing the abdomen, Ultrasound was performed to confirm breech presentation. At this time, the baby is now vertex. Position confirmed by attending as well. We discussed this with the patient while in the OR. She understands the risks of surgery and that cesarean delivery is unindicated at this time for fetal position of now being vertex. She reports she does not desire "to be sliced and diced" at this time if she can attempt a vaginal delivery. She was given options of induction of labor and wishes to proceed with induction via placement of foley bulb in the cervix and beginning pitocin. She understands that she will not be able to move from the OR table at this time as she has full spinal block. She is very cooperative and understanding. Will allow to recover from spinal and foley bulb was placed while she is in the OR and comfortable. Will begin pitocin once back in L&D suite. Once patient was back in L&D suite, epidural was placed for normal vaginal delivery but later an emergency c-section was performed. How would you code this? I know the normal vaginal delivery receives an anesthesia code of 01967 and the c-section is coded with 01968, but what about the spinal given for the first attempt at a c-section? 64412? Any information will be greatly appreciated.

 

[lovetocode]

My supervisor reviewed the case and stated we should bill the first C-section attempt as a cancelled case with a CPT of 59510 with a ICD-9 of V64.3. This makes sense. It is the simplest way. I was just worried about the insurance company rejecting two anesthesia claims for c-sections. But, I assume the cancelled diagnosis code and supporting documentation will take care of that.