I have an Anesthesia group that is billing for labor and delivery. Can someone clarify how to properly bill for a vaginal to caesarean delivery. We have currently billed with 01968 and 01960. They have paid the 01960 but are denying the 01968. We have used the QZ QS and physical status modifiers. Any guidance would be appreciated.
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Wiki Anesthesia billing for OB
- Thread starter Amberjo87
- Start date
jkyles
True Blue
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- 937
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Hi there, anesthesia billing for labor and delivery is very tricky. For more guidance: in addition to checking specific payer policies, check the ASA's practice management section, for example: https://www.asahq.org/quality-and-p...gement/coding-and-billing-for-labor-epidurals
You should also strongly consider hiring a consultant who can provide training.
You should also strongly consider hiring a consultant who can provide training.
thomas7331
Guest
The add-on code 01968 for the casearean delivery is typically billed in conjunction with 01967 for the planned vaginal delivery, not 01960. Is there something unusual going on in this particular case that would account for the use of 01960 instead?
LisaAlonso23
True Blue
QS modifier is not appropriate, as 01967 is for neuraxial labor anesthesia. When MAC is used in conjunction with an epidural, the epidural is the anesthesia method. QS is only used when MAC is the primary anesthesia method.
Hello, unfortunately we have no experience billing for these services so we are learning as we go. We are also facing issues with epidural anesthesia being denied when it is administered overnight. The insurances are rejecting the claim stating multiple DOS.
I will make the changes from 01960 to 01967 and resubmit the claim. Do either of you have any advice or insight on what tools you use to code for the anesthesia? I appreciate your assistance.
I will make the changes from 01960 to 01967 and resubmit the claim. Do either of you have any advice or insight on what tools you use to code for the anesthesia? I appreciate your assistance.