Anesthesia Coding Alert

Tip: Focus on these 3 areas to turn your denial rate around If you've compiled a list of your top-10 denials, comparing your top denial reasons with Medicare's will help you determine where you stand compared to other practices' most frequent denial reasons. Try this: Check your Medicare carrier's own top-10 reasons for denying claims. And for a more hands-on approach, read our experts' views on how three of these issues crop up in anesthesia or pain management practices -- and what you can do about them. 1. Ditch Duplicate Claim Submissions Even the most conscientious coder might have details slip through the cracks and inadvertently submit a claim twice. How you handle the situation depends on exactly what happened and why. "It might be a case of having two providers in the same specialty bill for the same service on the same day, such as an E/M service," says Jann Lienhard, CPC, a coder in New Jersey. "The carrier paid the physician whose claim reached them first, then denied the second." What to do: Check both claims to be sure the diagnoses and specialties are identical, and then talk with your providers. Some might say to forget it (especially if you're dealing with an E/M service); if not, get the medical records and see if there is a difference between the claims you might be able to appeal. Another scenario: Call the carrier to see when the original service was billed, by whom, and the resolution on the first billing. You might have submitted duplicate billing or resubmitted because the original submission was rejected for some reason. Don't miss: The most important piece of information to gather is whether you received double reimbursement. If so, you must refund the money. 2. Don't Botch Bundled Services "Most anesthesia services are bundled" with other services, says Scott Groudine, MD, an anesthesiologist in Albany, N.Y. The anesthesia fee includes services such as: • placement of external devices necessary for cardiac monitoring, oximetry, capnography, temperature, EEG, CNS evoked response, Doppler flow • placement of airway (endotracheal tube, orotracheal tube, etc.) or naso-gastric or oro-gastric tube • intraoperative interpretation of monitored functions (blood pressure, heart rate, respiration, oximetry, EEG, temperature, etc.) • placement of peripheral intravenous lines necessary for fluid and medication administration • nerve stimulation for determination of level of paralysis or localization of nerve(s). Note: Codes for EMG services are for diagnostic purposes for nerve dysfunction, Groudine says. The medical record must include a complete diagnostic report before you can submit these codes. What you can bill: The anesthesia service does not include some line placements, which means you can code separately when you have supporting documentation. These include: • arterial lines [...]