External Cephalic Version-01958

Reporting External Cephalic Version cases is tricky. Given the increased volume of questions on this topic, our team knew we needed to bring it to our community via ACE Alert!  

There is no one correct response to reporting 01958.  It all comes down to the circumstances. External cephalic versions become tricky because often these events are one step in a series of events. The associated timeline makes the difference. 

It may help to remember that each ASA code reported is a ‘package’ that consists of the pre-eval, intra-operative service, and post-anesthesia care. If there is clinically no reason for the pre-eval and/or post-anesthesia care to be repeated, it will be considered a single episode of care, reported with one ASA. 

Reporting External Cephalic Version examples

Example 1a:  The patient begins the episode of care by receiving an epidural to facilitate the external cephalic version (ECV).  After the ECV,  the epidural remains in situ to facilitate the next step of the planned service, the delivery.  Considering the rules of anesthesia coding, the higher-based ASA code, the delivery code, is assigned. Discontinuous time, for the time spent performing the ECV, is additionally captured. 

         Example 1b:  The patient begins the episode of care by receiving an epidural to facilitate the ECV.  During some point of the service, the patient begins labor, and labor/delivery care commences. Though planned to be separate events, this becomes one anesthesia event.  As described in Example 1a, report the appropriate delivery code(s) and capture relevant times for both the ECV and L&D services, considering the discontinuous time when appropriate.  

Example 2:The patient begins the episode of care for a planned ECV.  Once the ECV is completed, the epidural is removed, and the patient is discharged.  As planned, labor does not begin for several days.  In this scenario, the services will be reported separately, both the ECV (01958) and delivery codes with their respective times would be appropriate for the respective dates of service.  

Example 3: The ECV takes place with the expectation that the patient will deliver on a different day (as described in example #2).  The post-op eval is complete, and hand-off is performed.  At some point during the same date of service, the patient then experiences labor and returns for delivery care.  Both codes may be reported at their respective times.  A modifier will be necessary to identify these as separate events. 

Typically, most of these scenarios will fall under scenarios described within Example 1.  The key will be clear documentation to ensure the revenue team accurately assigns the times for both events performed.  

Please don’t hesitate to contact our team with any questions. We are here to help!

For more on External Cephalic Version, see our follow-up post on External Cephalic Version.