00300 00400

jfair021287

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I am getting a ton of denials for Dx not being medically necessary. Most of the CPT codes cross walk to these codes but yet the DX are denying. these are NOT situations where g8 g9 modifiers are used for MAC

HELPPP
 

lcole7465

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I am getting a ton of denials for Dx not being medically necessary. Most of the CPT codes cross walk to these codes but yet the DX are denying. these are NOT situations where g8 g9 modifiers are used for MAC

HELPPP
I would check and see if there is an LCD for the CPT code.
 

twizzle

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00300/00400 denials

It would be helpful if you could provide a couple of examples;perhaps these are procedures that wouldn't normally require anesthesia, or non-specific diagnosis codes. Difficult to tell without seeing something.
 

jfair021287

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So an example would be a skin cancer lesion biopsy lcd10 C44.391. CPT 11100- this then crosswalks to 00300

this issue is I don't believe that the ICD10 code is covered under 00300 but yet it is for 11100
 

thomas7331

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So an example would be a skin cancer lesion biopsy lcd10 C44.391. CPT 11100- this then crosswalks to 00300

this issue is I don't believe that the ICD10 code is covered under 00300 but yet it is for 11100
A skin biopsy is a non-invasive procedure that would not normally require the services of an anesthesiologist, so it seems logical that this would be excluded from coverage for that diagnosis, and you've already said above that this is not a situation where the G8 or G9 modifier would apply. So then can you give a little more information about when you would need to bill an anesthesia service for this procedure or give some examples of your billing scenario? Also, if you could say which MAC you're working with or region you're in we could maybe give you a little more information - as twizzle says above, it's difficult to say much without more detailed information.
 
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jfair021287

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ok heres one I came across today and I am from PA

Pt has chronic pain G89.4

pt is having an indwelling stimulator placed after completing trial 63685

Her posterior neck and right posterior and lateral lumbar region were prepped and draped in a normal sterile fashion. An appropriate time-out was taken, and her posterior cervical wound was opened sharply. The indwelling lead was disconnected from the externalized lead wire, and then the entire temporary externalized lead wire was removed from the patient in the field. I irrigated the wound with copious amounts of antimicrobial solution and then made a second incision over the right lateral and upper buttock region. A subcutaneous pouch was created. The cervical lead wire was then tunneled subcutaneously to the distal wound. I did add a 25 cm extension lead and connected it with a locking bolt mechanism. The lead was then inserted into a Nevro Senza 2 battery. Impedances were checked. All parameters were acceptable. The battery was then secured in the subcutaneous pouch with 0 silk sutures, and vancomycin powder was placed in the wounds.

Anesthesia type is GA- so the G8 modifier is not acceptable here
63685 cross walks to 00300 which the ICD10 code I believe will not be cleared for medical necessity

I am wondering why there is so many ICD10 codes that may link to the CPT code but not the anesthesia crosswalk code...mostly the 00300
 
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