roryash
Contributor
- Messages
- 11
- Location
- Philomath, OR
I am currently in a state of confusion when looking into specific coding scenarios and guidelines for an epidural converted to csection that takes place over multiple dates of service so I am posting here for some help.
Currently our local CCO Medicaid is denying encounters when the 01967 takes place on a different DOS than the 01968 due to the parent add-on code rule. The established process for our health system is to code the services on the dates there were performed per CPT guidelines and to also capture the provider info based on the csection times but whichever provider spent the most amount of time on the case (no matter the service) but the parent add-on code rule is also a guideline...
Our build looks like this on the 1500 form:
11/01/2026-11/02/2026: 01967
BEGIN 02:12 END 03:41
11/02/2026 : 01968
Because the DOS is different for 01968 than the start DOS for 01967 the claim denies. It appears that BCBS is jumping on this also.
My question to you all would be how are you coding these type of scenarios seeing as how the online resource material is about a clear as mud?
I recently did a few corrected claims with a box 19 comment explaining a continuous obstetric anesthesia case crossing midnight, still waiting on the results of that.
Currently our local CCO Medicaid is denying encounters when the 01967 takes place on a different DOS than the 01968 due to the parent add-on code rule. The established process for our health system is to code the services on the dates there were performed per CPT guidelines and to also capture the provider info based on the csection times but whichever provider spent the most amount of time on the case (no matter the service) but the parent add-on code rule is also a guideline...
Our build looks like this on the 1500 form:
11/01/2026-11/02/2026: 01967
BEGIN 02:12 END 03:41
11/02/2026 : 01968
Because the DOS is different for 01968 than the start DOS for 01967 the claim denies. It appears that BCBS is jumping on this also.
My question to you all would be how are you coding these type of scenarios seeing as how the online resource material is about a clear as mud?
I recently did a few corrected claims with a box 19 comment explaining a continuous obstetric anesthesia case crossing midnight, still waiting on the results of that.