CPT 01969: Anesthesia for Cesarean Hysterectomy after Neuraxial Anesthesia
CPT code 01969 denotes anesthesia services for a cesarean hysterectomy performed after neuraxial anesthesia. The code captures the specialized anesthetic management required when a cesarean delivery proceeds to hysterectomy, often for obstetric hemorrhage, uterine rupture, placenta accreta spectrum, or other intraoperative complications. Accurate coding for this scenario supports appropriate clinical documentation and payer adjudication for high-acuity obstetric anesthesia care.
Key national payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The discussion covers typical clinical context, billing relationships with related obstetric and anesthesia codes, and what clinicians and billing teams should expect when reporting anesthesia services in cesarean-to-hysterectomy cases.
Readers will find concise benchmarks and policy-relevant context for CPT code 01969, including how it differs from related anesthesia codes used for planned cesarean delivery or neuraxial labor analgesia converted to cesarean. The summary clarifies service type and typical site of service and highlights common clinical scenarios that generate use of this code. Data not available in the input will be noted where applicable.
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Billing Code Overview
CPT code 01969 describes anesthesia services provided for a patient undergoing a cesarean hysterectomy after neuraxial anesthesia. This procedure involves administering anesthesia care when a cesarean delivery is followed by hysterectomy, typically performed when intraoperative findings or maternal indications require removal of the uterus after delivery.
Service type: Anesthesia for cesarean hysterectomy following neuraxial anesthesia
Typical site of service: Operating room during a cesarean delivery with an immediate hysterectomy
Clinical & Coding Specifications
Clinical Context
A 32-year-old G2P1 at 39 weeks gestation with a prior low transverse cesarean presents in active labor with inadequate contractions (O62.0) and maternal exhaustion (O75.82). She had a previous cesarean documented as a low transverse scar (O34.211) and underwent a trial of labor after cesarean that becomes nonreassuring, resulting in a failed trial of labor after previous cesarean delivery (O66.5). The obstetric team decides to proceed with cesarean delivery; intraoperatively, extensive uterine atony and uncontrolled hemorrhage necessitate conversion to a cesarean hysterectomy after initial neuraxial anesthesia is in place.
The clinical workflow: upon diagnosis of labor dystocia and failed TOLAC, neuraxial labor analgesia or spinal/epidural anesthesia is already established. The anesthesia provider documents conversion from neuraxial labor anesthesia to surgical anesthesia for cesarean delivery, then provides ongoing anesthetic management when the case escalates to cesarean hysterectomy. Services include airway and hemodynamic management, blood product coordination, invasive monitoring as indicated, and emergence/hand-off planning. Documentation should note timing of neuraxial block, indication for hysterectomy, intraoperative events, and any concurrent procedures or complications.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when anesthesia or associated services are substantially greater than typical for cesarean hysterectomy due to complexity or complications. |
23 | Unusual anesthesia | Use when general anesthesia is administered for emergency or unusual circumstances when neuraxial techniques are contraindicated or converted. |
50 | Bilateral procedure | Rare for this code; not typically used but available for procedures documented as bilateral when applicable. |
52 | Reduced services | Use when the anesthesia service is partially reduced or procedure is abbreviated. |
53 | Discontinued procedure | Use if the procedure is started but stopped for patient safety prior to completion. |
62 | Two surgeons | Use when two surgeons of different specialties are documented as primary for portions of surgery; affects global surgical reporting and may impact anesthesia documentation. |
78 | Return to OR for related procedure by same physician | Use if patient returns emergently to the operating room for a related procedure and additional anesthesia services are provided. |
AA | Anesthesia performed personally by anesthesiologist | Use when the anesthesiologist personally performs the anesthesia services. |
QK | Medical direction of two, three, or four CRNAs/ANAs for part of case | Use when physician medical directs multiple CRNAs during the anesthesia for this procedure. |
QS | Monitored anesthesia care service | Use when care is billed as MAC rather than general or regional anesthesia, if clinically documented. |
QX | CRNA service with medical direction by physician | Use when a CRNA performs the anesthesia and a physician provides medical direction. |
QY | Medical direction of one CRNA by one physician | Use when a physician directs a single CRNA for the anesthetic. |
QZ | CRNA service without medical direction by a physician | Use when a CRNA provides services independently and documentation supports non-directed care. |
AD | Medical supervision by a physician: more than four concurrent anesthesia procedures | Use when the supervising physician oversees multiple concurrent anesthesia procedures beyond standard coverage. |
78 | Return to the operating room | See above; included due to clinical relevance for reoperation following hemorrhage. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207L00000X | Anesthesiology | Attending anesthesiologists commonly provide medical direction, advanced airway and hemodynamic management. |
367500000X | Certified Registered Nurse Anesthetist | CRNAs frequently deliver neuraxial and general anesthesia in obstetric operative cases. |
207V00000X | Obstetrics & Gynecology Physician | Obstetric surgeons perform cesarean delivery and may proceed to hysterectomy for hemorrhage control. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
O82 | Encounter for cesarean delivery without indication | Indicates planned or scheduled cesarean delivery encounters; relevant when cesarean is performed. |
O34.211 | Maternal care for low transverse scar from previous cesarean delivery | Documents prior uterine scar impacting trial of labor decisions and risk for repeat cesarean or hysterectomy. |
O75.82 | Maternal exhaustion complicating labor and delivery | Reflects labor-related maternal fatigue contributing to failed labor and need for operative delivery. |
O62.0 | Primary inadequate contractions | Describes labor dystocia prompting operative intervention and anesthesia escalation. |
O66.5 | Failed trial of labor after previous cesarean delivery | Indicates failed TOLAC leading to cesarean and potential intraoperative complications necessitating hysterectomy. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
01967 | Neuraxial labor analgesia/anesthesia for planned vaginal delivery | Represents initial neuraxial labor analgesia that may be present before conversion to cesarean hysterectomy; documents labor neuraxial services. |
59514 | Cesarean delivery only | Represents the cesarean delivery portion; used when billing cesarean without hysterectomy. Distinguishes primary cesarean from more extensive cesarean hysterectomy. |
01968 | Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia with additional procedures | Related when additional procedures accompany cesarean (e.g., bilateral tubal ligation); differentiates added complexity from conversion to hysterectomy. |
01960 | Anesthesia for vaginal delivery only | Represents anesthesia services limited to vaginal delivery; used for comparison to services when cesarean or hysterectomy is performed. |