Wiki labor epidural billing

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missyah20

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Hello all -

I have an unusal case and I'm not sure how to bill without receiving denials here (however we will probably receive them and have to appeal)

The patient was pregnant with twins. She delivered twin A on 11/5/14. They did a cerclage on 11/7/14. However removed the cerclage on 11/8 due to chorioamnionitis and pt had a second labor epidural for twin B on11/8/14.

My question here is do I bill 01967 on both 11/5/14 and 11/8/14?

Thanks!
 
Twin Epidural - Whopper

Wow Missy you have what I like to call a whopper,
I want to express that this is my "opinion" - I haven't had the opportunity to code one of these yet. But if I was to code this - I would bill two 01967 each with the appropriate DOS.
Questions I have are: Were they able to stop the contractions between days or was there some type of pain management?
Also providing the diagnosis codes - what are you using? Twins? Or chorioamnionitis for Baby B?
We have the ability in Epic to use procedure comments when billing procedures out. I am unsure if you have that ability, but if you do. I would label each procedure with Baby A Epidural for xxxxx and then Baby B Epidural for xxxxx. That may possibly eliminate a denial.
However odds are you will probably need to send in documentation with an appeal. So be proactive by sending the procedure notes when you send in the claims.
Also be sure to follow up - do a pop up for 30 days - see where the insurance company is for reimbursement. After that continue to do 15 day pop ups and watch the claims closely. Be proactive to whatever the insurance company adjustment codes are and act quickly if necessary.
I would love to know how this one turns out -
Good Luck!!!
Dana Chock CPC, CCA, CANPC, CHONC, CPMA
Anesthesia, Pathology and Laboratory coder
 
I have had a case like this in the past. They did deny and I did appeal and they finally paid. It did, however take some disputing with the insurance. First of all, make sure that you place the diagnosis code for twins as one of your primary diagnosis codes. Then use the -78 modifier for the second twin. Depending on the insurance company, this should pay when you place the 01967-78 onto the second baby.
Hope all turns out well
 
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