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Vaginal to C-Section Delivery Medicare Denial

Susan m Posted Fri 13th of March, 2015 10:21:42 AM

We have a denial on a Vaginal to C-Sec Delivery for a Medicare patient. We rarely ever code deliveries for Medicare patients. I'm not sure why this is denying. Here's what we have:

Vaginal Delivery 01967 AA P3
C-Sec 01968 QK P3

We also have PQRS codes for these
4047F, 4255F, 4250F

Do you know why this is denying?

Thanks so much! :)

SuperCoder Answered Tue 17th of March, 2015 03:05:01 AM

Hello,

Thanks for your question, in this situation we can't bill anesthesia for both C-section or Vaginal delivery, as per general anesthesia CPT guidelines, in one session, we should bill the service which has higher base value. Use of modifier QK is not applicable in this case because it should be use when the provider monitors multiple anesthesia sessions on different patient it should not be related.

So please bill only one code with higher base value.

for more understanding about the anesthesia services for deliveries refer below SuperCoder link:

https://www.supercoder.com/coding-newsletters/my-anesthesia-coding-alert/reader-questions-choosing-between-01967-and-01968-article

Hope this will help.

Thanks.

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