Multiple procedures on the same day.

I have two scenario that I would like your input on.

1) intrathecal narcotics (01967) for labor placed by provider A, two hours later provider B repeats intrathecal narcotics. Both providers are in the same group. Should provider B also get base (01967) plus time or just time?

2. Medicare (Noridian) is payor. Patient had an elective outpatient colonoscopy in a facility 75 miles away. She was discharged and went home. She had bloody bowel movement and went to the hospital in her home town (note 75 miles from first procedure). Another colonoscopy was performed by a different MD and MDA to find the GI bleed. Noridian denied as "procedure/service was furnished by another provider. A different Dx was used. Any suggestions on how to appeal this denial?

Comments

  • edited May 2017
    I will be out of the office until 6/13/2016. If you need immediate assistance please contact Sadie Meazell at 903-676-1189.

    Thanks,
    David
  • edited May 2017
    1) For billing purposes 01967 base is only billed once as description for this code indicates "(this includes any repeat subarachnoid needle placement and drug injection and/or any necessary replacement of an epidural catheter during labor)"

    2) Probably just have to appeal Medicare denial with records showing necessity of second procedure.

    Hope that helps.
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