# 99464 attendance at delivery



## soniavittori@gmail.com (Sep 17, 2013)

HI
Anthem Blue Cross is denying 99464 ( attendance at delivery) when billed with 99460 (initial hospital;/birthing center care).  

CPT books says both can be billed.  This was for a repeat C-section and the hospital policy is the pediatrician be in the room for C-section.

This is a personal bill and I am trying to appeal.  What is the best way to approach?  I am requesting medical records definitely.  THe insurance goes back and forth with either it's an "exclusion" of my plan, "non covered"service and then that it can't be the same pediatrician for both services?  

Is it common for groups to bill both?  

Thanks


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## asrabian (Sep 20, 2013)

We bill both codes and in my experience, the insurance companies also tell us it's "plan specific". My local BCBS patients pay but my out of state BCBS does not pay. United health NEVER pays us for the attendance and the initial. It's frustrating as I end up billing it out anyway and write off one of the visits if both do not reimburse.

I know this didn't really help, but I struggle with it as well.

Andi Srabian, CPC
Narragansett Bay Pediatrics


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## soniavittori@gmail.com (Sep 20, 2013)

Thanks, the pedi group won't write off the full amount.  My Anthem plan is administered by a 3rd party, so that's another problem.    I will still appeal it just to see maybe they will pay something.  Thanks for your help!


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## LINDA (Oct 23, 2013)

*2 issues*

I just now saw your post.  I hope I'm not too late to help.  I bill for a Neonatology group so we bill for attendance at delivery (99464) quite often.  

You have 2 potential issues.  The first issue is that 99464 requires the request of the delivering physician and a reason for the pediatrician to attend.    If your doctor only attended because it's hospital policy for all C-Sections, then there is no medical necessity.  We use code 99026 (hospital mandated stand-by service) for those cases.  However, most insurers won't pay that code.  The second issue is if 99464 is the appropriate code, CPT definitely says you can bill that along with 99460.  Some insurers require a modifier 25 to show it was performed separately from the 99460 (separate time & location).  I would add the modifier & appeal with a copy of the CPT language and a copy of the records.  I hope this helps!


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