Follow-Up on External Cephalic Version-01958

Last month, we shared information related to recording External Cephalic Version – 01958.  Your feedback and follow-up questions were helpful and greatly appreciated!

The previous information is included here, with two additional scenarios.

Reporting External Cephalic Version cases is tricky. 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. 

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 occurs.  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. Consider modifier 59, XE, or XP as suggested modifiers for Example 3.  These are only suggestions, and other modifiers may be appropriate depending on the payer. As a response to the first three examples, the question was received, “How do you code the ECV procedure when the conversion is not successful?”

New External Cephalic Version Reporting Examples

Example 4:  If the cephalic version is unsuccessful and the decision is made to proceed with a different service, repeat service, or C-section on a different day, then the recommendation is to report 01958 for the cephalic version on the appropriate date of service, and the appropriate code for the subsequent service on the date of service it is performed.  This is in line with example 2.   Much like a canceled case, it is permissible for the anesthesia service to report the intended yet unsuccessful procedure.  Keep in mind that diagnosis code(s) may assist with “telling the story” to the payer.

Example 5: If the cephalic version is unsuccessful and the decision is made to proceed to a different service on the same day, such as a C-section, then the recommendation is to report the appropriate delivery code(s) (or whichever alternate procedure has the highest base unit), with discontinuous time, like would occur in scenario 1.

Most ECV cases will fall under the scenario described within Example 1 (or 5). The key will be clear documentation to ensure the revenue team accurately assigns the times for both events.  

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