Anesthesia Coding Alert

Are we getting reimbursed for all the pain- management services we offer in our ambulatory surgery center (ASC)? Anesthesia providers and coding staff have been asking that question since April 1, 2000, when a long list of codes for spinal injection and treatment fell into a gray area for ASCs at least where Medicare was concerned. In May 2000, a HCFA program memo acknowledged all but nine of these codes as reimbursable for ASCs, because it considered them new procedure codes, not reclassifications of existing ones. Adding to the confusion, HCFA also proclaimed it would reimburse physician fees related to these procedures.

Providers will now get complete reimbursement for the procedures these codes cover. And anesthesia coders can recoup lost charges from 2000 and file correctly for procedures completed in 2001. (The codes involved are listed in the box below.)

However, just because HCFA has approved the codes for ASC use doesnt mean other carriers have, warns Joni Hyrick, executive vice president of Pain Treatment Centers of America in Buffalo, N.Y. Our carrier, Noridian (Blue Cross/Blue Shield of North Dakota), didnt have its software reprogrammed correctly for these codes until this year. Once they reprogrammed the software, we resubmitted claims from 2000 for these services and were reimbursed for most of them.

2001 Reimbursement Not Always Automatic

You should also be on the alert for other issues associated with HCFAs reversal. For example, Hyrick says that even though Noridian is paying most claims billed with these codes, it considers the procedure associated with code 62263 (definition below) as an experimental and unproven procedure and denies both the professional and ASC charges for it. The carrier has instructed providers to report the procedure with code 64999 (unlisted procedure, nervous system).

Workers compensation carriers, which tend to be a bit slower about accepting changes in policy, could present other problems. Some still use 1999 CPT codes instead of the 2000 or 2001 updates a providers paperwork nightmare. To address this issue, Hyricks group explains its use of the new codes by referencing the 1999 and prior codes on the narrative section of the claim form along with the most applicable current codes. If we forget to cross-reference the codes, well receive only partial payment for the service and then have to review and resubmit charges, she says, adding that this is true for both professional and technical charges in the states they serve.

Getting Paid for Denied or Outstanding Charges

Hyrick recommends working as soon as possible with local carriers to recoup delayed or denied reimbursement. Most practice management systems allow you to run a plan rebill report and automatically regenerate claims for resubmission when you outline the criteria, she explains. All [...]