Wiki 76942 denials from WPS for CRNAs

[missyah20]

Just a quick question -

Has anyone started seeing denials for code 76942 with a 26 modifier from WPS Medicare when billed by a CRNA stating that they are not allowed to bill this code?

We have been billing this for CRNAs in Iowa who are also ARNPs and have been receiving payment from Medicare until recently.

I haven't been able to find any information regarding this on the WPS website. I know that in 2011 they had an article under their Part A page regarding chronic pain managment, but I can no longer find it on the website.

Just curious if anyone else has been dealing with this.

Thanks!

 

[lenora rodes]

WPS MedicaWPS Medicare Part B Legacy eNews for Monday, September 24, 2012

III. NON-PHYSICIAN PRACTITIONERS AND RADIOLOGY SUPERVISION
Question: Can a nurse practitioner provide the supervision for radiology service instead of the physician? Can the nurse practitioner perform a radiology service?
Answer: Nurse practitioners, clinical nurse specialists, and physician assistants are not defined as physicians under §1861(r) of the Act. Therefore, they may not function as supervisory physicians under the diagnostic tests benefit (§1861(s) (3) of the Act). However, when these practitioners personally perform diagnostic tests as provided under §1861(s) (2) (K) of the Act, §1861(s) (3) does not apply and they may perform diagnostic tests pursuant to State scope of practice laws and under the applicable State requirements for physician supervision or collaboration.
The above is a portion of the information found in the Centers for Medicare & Medicaid Services (CMS) Internet Only Manual (IOM) Publication 100-02, Chapter 15, Section 80.


This WPS Medicare eNews may answer your question.

Lenora, CPC, CANPC, COBGC

 

[JackieM]

Just a quick question -

Has anyone started seeing denials for code 76942 with a 26 modifier from WPS Medicare when billed by a CRNA stating that they are not allowed to bill this code?

We have been billing this for CRNAs in Iowa who are also ARNPs and have been receiving payment from Medicare until recently.

I haven't been able to find any information regarding this on the WPS website. I know that in 2011 they had an article under their Part A page regarding chronic pain managment, but I can no longer find it on the website.

Just curious if anyone else has been dealing with this.

Thanks!

Here is an article on Decision Health website, Anesthesia and Pain Coder's Pinksheets from April 10,2013 stating WPS is denying incorrectly, and to appeal.


"April 10, 2013 by: Julia Kyles

Last Reviewed April 9, 2013

This isn't a problem from a quantum physics pop-quiz. It is the denial anesthesia practices in WPS's territory are seeing when their CRNA's bill for ultrasonic guidance for needle placement (76942-26).


When Dottie Buck, Billing, Kearney Anesthesia Associates, P.C., Kearney, Neb. started getting denial PR-172 (Payment is adjusted when performed/billed by a provider of this specialty) when CRNA's performed the professional component of the service (76942-26), she knew something was amiss. She reached out to the Anesthesia & Pain Coder's Pink Sheet, which turned to the American Academy of Nurse Anesthetists.


Turns out that for reasons as yet unknown, WPS has stopped paying CRNAs for this service. But AANA is on it. “The AANA is aware of these denials for ultrasound guidance and has communicated with WPS Medicare to request that they resume direct reimbursement for this service,” replied Romy Gelb-Zimmer, associate director, federal regulatory and payment policy, for AANA's Washington office. The agency does not currently know when WPS will fix this snafu. For now, AANA's advice is to submit your claims and appeal the denials.


And our advice, keep an eye on upcoming issues of the Anesthesia & Pain Coder's Pink Sheet for the final answer to this unexplained denial problem."