Wiki coding 01968 as a stand alone

[bar2ty@yahoo.com]

Anesthesia provided obstetrical care on 6/24, then provide a C-section on 6/25. Our coding team submitted a to Medicare for: 01967 QY P2, dos 6/24, and on the same claim submitted: 01968 QY P1, dos 6/25. Coding also submitted claim 01968 QX P2 (C-section) as a stand alone code. Medicare denied claim for: add on code can not be billed by itself. Am I missing something, or should our coding team know this guideline. How do we obtain payment for the C-section performed by the anesthesia QY and the QX? Any input is appreciated.

 

[TAMINA]

Hello, Anesthesia Deliveries can be tricky. The 01967 is for labor analgesia for planned vaginal delivery/epidural placement during labor, now if something goes wrong during labor and the provider needs to do a c-section you would use 01968.
You would calculate your time when your labor epidural started and when the patient entered the OR for your start and stop times for your 01967. Then your start and stop times for the 01968 would be when they started and ended the c-section. And don't forget your modifiers. Trust me this stuff is tricky and just when I think we all have it down, something changes. good luck we are all in the same boat.