Wiki anesthesia billing

[fimachris@yahoo.com]

I have worked for family practice billing for 22 years and have recently switched jobs to a speciality practice that does spine injections with anesthesia in the office. So I am new to anesthesia billing. I am having issues with Humana and Anthem denying the new anesthesia code 01937-10938 for epidural steroid injections. these codes replaced 01936. we use a QZ modifier for our anesthesiologist but they are denying this new code saying invalid code/modifier. has anyone else have this issue and can you steer me to some education on this type of coding claims?

 

[jkyles]

Hi there, I recommend checking the payers' policies. Guidelines for anesthesia with interventional pain treatments may be in their policy for the procedure or the anesthesia policy or they may have separate policies for monitored anesthesia care (MAC) or MAC/Anesthesia with interventional pain management.

Payers have strict limitations on anesthesia with pain treatments, the diagnosis code and the documentation will need to support the medical necessity of anesthesia for eachpatient.

 

[LisaAlonso23]

If the date of service is 1/1/2022 or later, I would first suggest calling them to confirm they updated their systems with the new codes.

At ACE, we add an additional diagnosis to justify the use of anesthesia regardless of the type of anesthesia administered to prove medical necessity for anesthesia service. If General anesthesia was used, no additional modifier is necessary. If MAC was used, QS needs to be appended along with a diagnosis from your Medicare Administrative Contractor's LCD list if one those diagnoses is provided on the anesthesia record. Many Medicare Administrative Contractors have a list of diagnoses for MAC anesthesia.

 

[silvaspoon82]

Have you looked into the injection codes from the Nervous System Section? They are reported for single or multiple injections. I have only used the anesthesia codes listed above for continuous anesthesia time. Such as L&D and surgery. I have coded and billed anesthesia for over 6 years to any and all insurances and for self-pay. As well for the professional and facility setting, and for pain management, L&D and surgical.