IndianaAIM Resolutions Manual ESC 6661.2

AUDIT NAME: DURAMORPH CAN NOT BE BILLED ON SAME DAY AS SURGERY

CLAIM TYPE: / M, B / HEADER/DETAIL: / Detail
LOCATION: / 22 / OVERRIDEABLE: / Yes
PROGRAMS: /

All

/ ALLOW DENIAL: / No
RECYCLE DAY: / 0
DISPOSITION: / B / M

Paper Claim

/ Suspend / Suspend
ECS / Deny / Deny
Shadow / Deny / Deny
POS / Deny / Deny
Adjustments / Deny / Deny
Special batch / Suspend / Suspend

AUDIT DESCRIPTION:

This contra-indicated Audit will fail when procedure code 01996 is billed on the same day as the epidural is placed by the same or different rendering provider. 01996 is only billable on subsequent days when the epidural is actually being managed. Procedure code 01996 is used for daily management of patients receiving continuous epidural, subdural, or subarachnoid analgesia. Code 01996 is limited to one unit per day for each day of management.

AUDIT CRITERIA:

Claim will deny if code 01996 is billed on the same day by the same or different rendering provider as a surgical code (range 10000 – 69999).

EOB CODE:

6661 Duramorph can not be billed on the same day as surgery.

METHOD OF CORRECTION:

Documentation must be present to show that the 01996 is not related to the surgical service performed on the same day.

The audit is overrideable if the surgical code is unrelated to the pain management (e.g., line insertion not for the administration of pain meds.)