Wiki Is there a modifier for OB epidural in anesthesia coding?

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Recently I received a few anesthesia coding denials from Medical Mutual stating that there were missing necessary modifiers for OB epidurals with CPT code 01967. Is anyone aware of what missing modifier they are talking about and if so can you please enlighten me. Thank you so much in advance and have a great day!


PHE.
 
Hello MagentaMoon67, the procedure was performed by a CRNA, and the QZ modifier is already there, but they are still saying there is a missing required modifier. Thank you for your prompt response. Do you know of any other modifier they could be referring to?
 
Hello MagentaMoon67, the procedure was performed by a CRNA, and the QZ modifier is already there, but they are still saying there is a missing required modifier. Thank you for your prompt response. Do you know of any other modifier they could be referring to?
Oh, OK. the QZ wasn't mentioned on your post, sorry about that-LOL I wonder if they are wanting a physical status mod ? Did they specifically state that they were looking for an obstetric mod ? The physical status mod is the only one that I can think of in addition to the normal anesthesia mods.
 
Oh, OK. the QZ wasn't mentioned on your post, sorry about that-LOL I wonder if they are wanting a physical status mod ? Did they specifically state that they were looking for an obstetric mod ? The physical status mod is the only one that I can think of in addition to the normal anesthesia mods.
Sorry about the lack of clarity. The QZ as well as the physical status modifiers are both present and they are still stating there is a missing modifier. It has me totally stumped to be honest with you.
 
Sorry about the lack of clarity. The QZ as well as the physical status modifiers are both present and they are still stating there is a missing modifier. It has me totally stumped to be honest with you.
I am stumped right along with you my friend ! Did you call, or are you just reviewing the EOB ?
 
I did contact Medical Mutual and was told that they could not tell me what modifier was missing. Not very helpful on their part.

Were there any other codes billed on the same claim that could be hitting an NCCI edit?

(Seems unlikely, but I thought I'd ask since that could be a situation where they'd want an additional modifier.)
 
Were there any other codes billed on the same claim that could be hitting an NCCI edit?

(Seems unlikely, but I thought I'd ask since that could be a situation where they'd want an additional modifier.)
Good day Susan, as far as I know there were no other codes billed on the same claim. Thank you so much for your input. I am more than open to anything else you may have to share.
 
Good day Susan, as far as I know there were no other codes billed on the same claim. Thank you so much for your input. I am more than open to anything else you may have to share.
I looked up medical mutual and 01967 to see if I could find anything about an elusive modifier-wasnt successful.. But did find a "draft" of a March 23 provider manual stating that the anesthesia for continuous epidural during delivery, should be billed using the CPT code 59400, not the ASA code.

Here is exactly what it says" for example, a claim for Continuous Epidural Infusion for anesthesia during routine labor and delivery should be submitted using CPT code 59400 and the appropriate number of time and/or modifying units"
 
In order to respond, I would need to see the coding submitted and the op note. There are so many variables to consider. Often times, the denial reason is not accurate. They just need to give a reason.
Start by verifying the patient's insurance and that all information submitted is correct. Then, check the coding.
 
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