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Add On Codes - services performed

baileycode

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Augusta Georgia
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According to CPT section on Add-On Codes it states "The add-on code concept in CPT 2008 applies only to add-on procedures or services performed by the same physician". My questions is what if ,and there are several circumstances when the base code such as 01967 (base) and 01968 (add-on). These are codes for laboring epidural (01967) that then goes to C-Section (01968) - the 01967 will be started by provider A - but because labor can be many hours long provider A isn't available and provider B provides the anesthesia for the C-section, therefore leading to the denials. Is there anything out there that will support my argument that some add on codes do not HAVE to be performed by the same physician. Another example code set is 33960 and 33961 - these codes are time increment codes of 24 hours, therefore the add on codes could not POSSIBLY be done by the same provider. ANY HELP is greatly appreciated.
 

dmaec

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Hibbing, Minnesota
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but the providers belong to the same practice and same level of profession right? if so, they're considered "the same".

{that's my opinion on the posted matter}
 

baileycode

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Augusta Georgia
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Thank you for the response - they are in the same group, in fact one is a teaching facility, I was hoping to find anything that is hardcopy that I can quote this to use in an appeal argument. However, this is helpful and will add to my argument in leu of HC documentation. Thank you.
 
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