Wiki How many ECVs are you allowed to bill on 1 day?

[MaureenDL123]

Pt. Admitted for IOL. Pt. had an ECV for unstable lie. How many ECVs can be done on one day by the same Provider? At 2:45 pm a successful ECV was performed. At 4:20, baby moved to Transverse lie and pt. Desired another ECV, which was done and successful. At 10:21 baby moved again, another ECV was done and successful. Can you bill for all 3 or just for one? Thank you.

 

[nielynco]

Pt. Admitted for IOL. Pt. had an ECV for unstable lie. How many ECVs can be done on one day by the same Provider? At 2:45 pm a successful ECV was performed. At 4:20, baby moved to Transverse lie and pt. Desired another ECV, which was done and successful. At 10:21 baby moved again, another ECV was done and successful. Can you bill for all 3 or just for one? Thank you.

There is nothing in CPT rules that preclude doing so and there is also no MUE (Medicare unlikely edits) for code 59412 either. You should, however, list the code 3 times and use a modifier -76 to indicate a repeat service to avoid a denial for duplicate billing.

 

[MaureenDL123]

Thank you so much!

 

[csperoni]

I am seeing an MUE of 1 on 59412 per Codify. The MAI is 3 which means it would initially deny, and you may be paid for more than 1 upon documentation of medical necessity. I agree with @nielynco that all 3 should be billed. I would suggest:
59412
59412-76 x2
In theory, this would result in the first 59412 paid and 59412-76 x2 being denied and appealed and hopefully eventually paid.

 

[MaureenDL123]

I am seeing an MUE of 1 on 59412 per Codify. The MAI is 3 which means it would initially deny, and you may be paid for more than 1 upon documentation of medical necessity. I agree with @nielynco that all 3 should be billed. I would suggest:
59412
59412-76 x2
In theory, this would result in the first 59412 and 59412-76 x2 being denied and appealed and hopefully eventually paid.

Thank you so much!

 

[nielynco]

I am seeing an MUE of 1 on 59412 per Codify. The MAI is 3 which means it would initially deny, and you may be paid for more than 1 upon documentation of medical necessity. I agree with @nielynco that all 3 should be billed. I would suggest:
59412
59412-76 x2
In theory, this would result in the first 59412 paid and 59412-76 x2 being denied and appealed and hopefully eventually paid.

Good idea.