aruiz9599
New
Our anesthesia practice has run into an issue where insurances are denying add-on code 01968 because it was performed by a different provider than the provider that billed primary procedure code 01967. The procedures are being performed by different providers because the epidural can run for hours before the decision to perform the c-section is made. This leads to the primary procedure code and the add-one code being billed on separate claims. Insurances will pay the primary procedure code (01967) but will deny the add-on code stating that the primary procedure code has not been billed. When the denial is appealed using the fact that the primary procedure code was billed and paid for on a separate claim the insurances uphold their denial and reps from different insurances have stated that it is because the codes were billed by different providers. Has anyone had any experience with this situation? I've tried looking at billing manuals and guidelines and can't seem to find anything concrete that either states the procedures have to be performed by the same provider or a way to set up the charges so that both are paid. This is in Texas in case that matters. Thank you in advance for the help.