Reimbursement Advisor

Modifier needed to bill for anesthesia

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Q An external cephalic version was performed on a breech baby as an outpatient procedure. I was told I could bill 01958 (Anesthesia for external cephalic version procedure) for the anesthesia, but have gotten an insurance denial because the “CPT and ICD logic do not match.” We used the diagnostic code 652.2. Are there some rules about anesthesia I should be aware of?

A There may be more than 1 problem here. First, the anesthesia codes are meant to be billed by the anesthesiologist, not the physician who is also performing the procedure. You have not indicated whether this was the case.

If you did perform the version procedure as well as providing the anesthesia to the patient, you would need to indicate this by adding a modifier -47 (Anesthesia by surgeon) to code 59412 (External cephalic version, with or without tocolysis). You would then report a 2nd code for the type of regional anesthesia you administered. For instance, if you used epidural anesthesia, you would report 59412-47, 62311 (Injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; lumbar, sacral [caudal]).

If you were only providing the anesthesia, then code 01958 is correct, but now the payer is indicating a mismatch between the CPT code and the diagnosis code.

You have indicated that you used code 652.2 (Breech presentation without mention of version). But as you are billing for anesthesia for a version, this code would no longer be correct. In this case, the more correct code would be 652.13 (Breech or other malpresentation successfully converted to cephalic presentation; antepartum condition or complication) if the version was successful or 652.03 (Unstable lie; antepartum condition or complication) if it was not.

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