Order of ICD 9

[cats2195]

I am new to anesthesia coding and have a question in regards to the order of the ICD 9 codes. We have had several claims denied for "not medically necessary". The claims included ICD 9 codes justify the procedure but not the need for supervised anesthesia. We are doing corrected claims but in what order do the ICD 9 codes need to be listed? ICD 9 justifying the procedure first or ICD 9 for the anesthesia?

Thanks for your help!!

[missyah20]

The primary diagnosis should be the reason for the procedure. After that I would add any secondary diagnosis that help to support the need for a separate anesthesia provider.

Make sure to check with your Medicare carrier and/or other insurance providers for any LCD's/medical policies that pertain to the denial to see what codes support this need.

[cats2195]

Would this apply to all Medicare. We are particularly having issues with Trailblazer, Texas Medicare?

[missyah20]

I am assuming the denials are for Monitored Anesthesia Care. Yes, Trailblazer Medicare (who is the Part B carrier for Texas) does have a MAC policy. Not all Medicare Carriers have MAC policies in place.

Below is a link for their website. It brings you to the page to seach for LCDs. Just type in Monitored Anesthesia Care and it will bring you their LCD.

http://www.trailblazerhealth.com/Too...spx?DomainID=1