Anthem BC/BS denials Epidural for Labor

lulubelle2004

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We are receiving multiple denials from BC/BS when billing our epidurals for labor (01967) using Z33.1. We've billed this code to Anthem since the implementation to ICD-10 in 2015 with no problem. Other carriers require O80 followed by the Z code for the outcome of delivery and weeks of gestation. We tried these codes with Anthem also and they are also kicking back. Is anyone else having this issue?

Many thanks in advance for your responses.
 

danachock

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Hi lulubelle2004,
Reading your post there may possibly be something more to this than simply the diagnosis code(s) because you stated that originally you were applying Z33.1 but then changed utilizing O80, with outcome of delivery and weeks of gestation. Out of pure curiosity I did review the BCBS Anthem for Providers website (I'm unsure which State we are dealing with but BCBS Anthem covers several) and I may have stumbled onto something?? I'm unsure, because I do not have the specifics on your denial(s) - we know that 01967 would have been billed for the labor epidural but I do not have the minutes billed, modifier(s) billed, diagnosis code(s) provided or all of the adjustment codes provided on the denial.
Interesting - I haven't worked anesthesia denials for awhile so this is new information for me. I'm also unsure when BCBS Anthem implemented this policy (it simply doesn't state). But the information I stumbled onto states that BCBS Anthem has a policy "Elimination of Non-medically indicated (Elective) Deliveries Before 39 Weeks Gestational Age Toolkit". Reviewing this policy if the patient was provided a labor epidural earlier than 39 weeks it would be inappropriate to bill O80 (Encounter for full-term uncomplicated delivery). For deliveries prior to 39 weeks BCBS Anthem would expect the assignment of diagnosis code(s) for the reason(s) why the patient would be allowed to deliver prior to 39 weeks.
If I had a little additional information I may be able to assist figuring out your labor denial(s) issue and hopefully prevent future denials.
Thanks for listening,
Dana Chock, RHIT, CPC, CANPC, CHONC, CPMA, CPB
Coding Analyst (May 2018-present), Anesthesia Coder (April 2013-May 2018), Pathology & Laboratory Coder (Fall 2012-May 2018)
Resources:

BCBS Anthem website:
https://www.anthem.com/wps/portal/ahpprovider?content_path=provider/noapplication/f1/s0/t0/pw_b140283.htm&label=Tools and Resources for Providers&rootLevel=1&state=wi&rootLevel=0

From the above link I selected:
3918

Which brought me to this website:
https://www.marchofdimes.org/professionals/less-than-39-weeks-toolkit.aspx
 

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