Wiki 01992/aaqs - palmetto

[jlb0807]

Hello!

I'm hoping someone can help. We just recently switched over from Cahaba to Palmetto. We are getting rejections on anesthesia claims that we don't understand. One of my doctors billed out an ESI and SNR. My other doctor is trying to bill out the anesthesia for the claim. The rejection that we are getting on the anesthesia says "procedure code inconsistent with modifier or required modifier is missing." Can anybody shed any light on this for us?

Doctor #1
62323
64483

Doctor #2
01992/AAQS

Thanks in advance!
Jessica

 

[MelYo919]

Palmetto Anesthesia Modifiers

Here is a link to Palmetto's latest Anesthesia Modifiers, news and usage. (You will have to copy the whole thing and paste into your browser to go). If you go your region, then choose browse by topic and then you can choose anesthesia to review other documentation too. Hope it helps you.

Link to article: https://www.palmettogba.com/palmett...ty~Anesthesia Pain Management~8E4KDP4751?open


Melissa Young

 

[lcole7465]

Hello!

I'm hoping someone can help. We just recently switched over from Cahaba to Palmetto. We are getting rejections on anesthesia claims that we don't understand. One of my doctors billed out an ESI and SNR. My other doctor is trying to bill out the anesthesia for the claim. The rejection that we are getting on the anesthesia says "procedure code inconsistent with modifier or required modifier is missing." Can anybody shed any light on this for us?

Doctor #1
62323
64483

Doctor #2
01992/AAQS

Thanks in advance!
Jessica

I'm not that familiar with Palmetto, but we use 01992 for 62323 & 01935-59 for 64483 since this is transforaminal epidural.

 

[jkyles]

Hello,
it could be that Palmetto has stricter requirements for MAC. Palmetto's guidance for MAC states in part:

MAC provided by qualified anesthesia personnel may be reimbursed for these procedures only when one or more of the following conditions are met:

1. It qualifies for use of HCPCS modifier QS:

MAC is appropriate for:

• Combative patients
• Patients with low pain thresholds or who experience severe pain
• Situations where the surgeon anticipates the possible intra-operative expansion of a procedure
• Any condition in a Medicare eligible pediatric patient less than 12 years of age
• The patient has a physical status grade of P3 or higher noted in the medical record

https://www.palmettogba.com/palmetto/providers.nsf/DocsR/JJ-Part-B~7KWQYH7878