Anesthesia Coding Alert

Keep these 6 steps in mind as you refile transforaminal claims

Medicare changed its stance on bilateral transforaminal procedures, saying surgical indicator "1" does apply to +64480 (Injection, anesthetic agent and/or steroid, transforaminal epidural; cervical or thoracic, each additional level [list separately in addition to code for primary procedure]) and +64484 (... lumbar or sacral, each additional level [list separately in addition to code for primary procedure]).
 
That means you can append modifier 50 (Bilateral procedure) to your claims when appropriate and be reimbursed accordingly -- so many coders have a stack of claims to refile.
 
Follow these steps from New Jersey coding consultant Jann Lienhard, CPC, to find success with your appeals instead of more headaches:
 
1. Identify the incorrect processing so you can refile the claim.
 
2. Pull any supporting documentation (the original patient chart, notes regarding bilateral injections, etc.).
 
3. Call the carrier and ask for a claim and appeal number (Aetna and UnitedHealthcare give you a tracking number so you know where the claim stands, for example). Verify whether you can refile the claim by  phone or fax or if you need to mail a hard copy of the documentation to the carrier.
 
4. If the carrier does not accept appeals by phone or fax, mail in the documentation. Include a copy of the original claim and the incorrect reimbursement, along with a cover letter explaining why the insurer should reimburse the claim differently. 

5. If you refile the claim by phone or fax, expect the carrier to take about 10 days before responding; allow a month for responses to claims you mail.
 
Once that time period has passed, begin following up until the carrier responds. Some carriers tend to wait until you send a second appeal before processing the claim.
 
6. When you receive correct payment, call the representative who helped you. Thank him, and keep his name on file for assistance with future claims.