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Carla Posted Mon 27th of November, 2017 22:55:46 PM
Hi there, Patient was in a C-section following a failed V-Back due to Fetal Distress. She had Vaginal bleeding and during the C-section a hysterectomy was performed. Can you please help me with these coding this procedure. Thank you for your help.
SuperCoder Answered Tue 28th of November, 2017 01:43:13 AM



Many women initially have a labor epidural but progress to a cesarean section during labor for any number of reasons (failure to progress, a rise in blood pressure, or a drop in the baby's heart rate etc.).


Billing for the labor epidural and C-section independently means the anesthesiologist overestimates his work value since some services (such as preoperative evaluation and IV insertion) for the C-section are included in the labor epidural and shouldn't be paid twice. But coding for only one type of delivery or the other is not fair either.


Billing only the C-section sometimes put you at risk for denial because the carrier would think the amount of time billed is unusual for a labor epidural. Billing only the labor epidural is not fair to the anesthesiologist because it severely underestimates the work associated with an urgent C-section.


The add-on codes help resolve these situations by giving anesthesia providers the means to report services more accurately even if reimbursement stays the same. For example, code for anesthesia during a cesarean hysterectomy 01963 (Anesthesia for cesarean hysterectomy without any labor analgesia/anesthesia care) doesn't accurately report the situation if the patient began with a labor epidural. Now you have the option of coding a hysterectomy at the time of a C-section following a labor epidural with 01967 and 01969. Both ways of reporting the hysterectomy equal 10 units (10 units for 01963, and 5 units each for 01967 and 01969), but the claim is clearer and the anesthesiologist receives the appropriate reimbursement for his services if you use the two codes together.


You can report services more accurately with these add-on codes. The time involved with a continuous labor epidural does not require the anesthesiologist to be in direct attendance with the patient, but a C-section does. Anesthesiologist can report the time accurately along with the work associated with each procedure.



Carla Posted Tue 28th of November, 2017 11:49:07 AM
Thank you for that explanation!! So would I use the DX code of O80 first followed by O34.211 (previous C-section) followed by O36.8990 (fetal distress) followed by the Vaginal Bleeding code (which I do not know) with Procedure codes 01967/01969? Thank you, Carla
SuperCoder Answered Wed 29th of November, 2017 06:19:32 AM



If your documentation supports, you may use these codes. Code O34.211 should be used if there is a scar from previous cesarean delivery and also follow instructions such as "Code first" and "Use additional code" depending upon your documentation. For fetal distress, you should use code O77.9 instead of O36.8990. The correct diagnosis code for an unsuccessful VBAC depends on the reason why it was unsuccessful, such as fetal distress in this case.



Carla Posted Wed 29th of November, 2017 20:20:47 PM
Thank you.
SuperCoder Answered Wed 29th of November, 2017 23:35:36 PM

Your welcome!

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