Our experts reveal how you can avoid unnecessary denialsWhen one Part B Medicare carrier recently alerted anesthesia practices to the top allowed and denied CPT 2007 codes, endoscopy codes 00810 and 00740 made both lists.In fact, 00810 and 00740 have been the talk nationwide. Let our experts tell you how to submit clean claims for these codes, spot the top reasons for denial and stay on top of which payers may be changing their policies yet again.Match 00810 and 00740 to Proper ProceduresHighmark, Pennsylvania's Part B carrier, included 00810 and 00740 on its top allowed and denied lists, which you can find on its Web site at
http://www.highmarkmedicareservices.com/partb/reference/denial-reports/2007/cover.html.Typically you'll use 00810 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum) and 00740 (Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum) when you see anesthesia used for esophagogastroduodenoscopies and upper gastrointestinal endoscopies (EGDs), endoscopic retrograde cholangiopancreatographies (ERCPs) and colonoscopies, says Cindy Lane, CPC, CHCC, with Advanced Coding Solutions in Whitehouse, Tenn.The first thing you need to know is that the EGD code range (43234-43259) and the ERCP services (43260-43272) cross to anesthesia code 00740. And colonoscopy surgical codes 45378-45392 cross to 00810.Coding Pain-Free Endoscopy Isn't PainlessYou have probably been seeing a lot of 00810 and 00740 lately as anesthesia for endoscopies becomes more commonplace."This procedure is growing in popularity, as most people are expecting pain-free endoscopy," says Scott Groudine, MD, an anesthesiologist in Albany, N.Y. "However, it is because of this growth that insurance companies are cracking down on these cases and rejecting claims at a growing rate."Watch this problem area: Denials are typically due to the diagnosis not meeting a payer's criteria for payment, says Julee Shiley, CPC, CCS-P, CMC, an anesthesia coding consultant in South Carolina. "Some payers make allowances for personal or family history of malignancy for screenings," she says. Payers typically have utilization limits, such as a screening every so many years, and you may see denials if you don't indicate the correct diagnosis."Also, if the patient is not of the correct age for the screening and there are no findings or symptoms, this may also be denied," Shiley says.Tip: Look to the V-code section of ICD-9 for screening and "history of malignancy." For example, report a special screening for colon cancer with V76.51 (Special screening for malignant neoplasms; colon) and a personal history of esophageal cancer with V10.03 (Personal history of malignant neoplasm; esophagus).Experts note: Local or IV sedation services that the surgeon can normally provide also run the risk of denial.Prevent Denials With ICD-9 AccuracyWhen you use 00810 and 00740, you know that your diagnosis codes need to be on the money every time.Good news: In most cases when [...]
