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01996 on the same day as the procedure??

  1. #1
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    Columbus, Ohio
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    Question 01996 on the same day as the procedure??
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    I can't find any documentation that states whether or not we can bill a 01996 on the same day as the primary procedure. Our doctors think we should be reimbursed for this, yet I can't find anything that states that. We're in Ohio, and I found an LCD for NY that says we can't bill a 01996 on the same day as the cath insertion. We've checked all our books and I've Googled it, but I need concrete proof. Help!!
    Taryn N. Linstedt, CPC

  2. Default
    Quote Originally Posted by linstedtt View Post
    I can't find any documentation that states whether or not we can bill a 01996 on the same day as the primary procedure. Our doctors think we should be reimbursed for this, yet I can't find anything that states that. We're in Ohio, and I found an LCD for NY that says we can't bill a 01996 on the same day as the cath insertion. We've checked all our books and I've Googled it, but I need concrete proof. Help!!
    Reply-
    Cath insertion should be billed first along with an E and M code appending a 25 modifier to the E and M, and then the other services as required. Then the visit should be paid.

  3. Default
    Quote Originally Posted by linstedtt View Post
    I can't find any documentation that states whether or not we can bill a 01996 on the same day as the primary procedure. Our doctors think we should be reimbursed for this, yet I can't find anything that states that. We're in Ohio, and I found an LCD for NY that says we can't bill a 01996 on the same day as the cath insertion. We've checked all our books and I've Googled it, but I need concrete proof. Help!!
    If you are coding for anesthesia, then I assume that you are questioning post-op pain injections/followup. If so, it depends on what the catheter was originally placed for - was it placed for the mode of anesthesia first, and then used for the post op pain mngmt, or was the epidural placed strictly for post op pain mngmt?

    If placed strictly for post op pain, you would use 62318 or 62319 depending on the location/level that the catheter was placed. If this was performed on the same day as a surgical procedure, you would append the 59 modifier to the 62318/62319 code. The follow-up days (starting the date AFTER the surgical procedure), are to be coded 01996 with no modifier.

    If the epidural catheter was placed as the mode of anesthesia, then no, you cannot bill for the epidural placement (62318/62319), nor can you bill 01996 on the same day. However, the followup days are billed as 01996.

    Hope this helps.

    LaSeille Willard, CPC

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