Question Anesthesia CPT 00811 and 00731- Denials

[Lholt0522]

I have been getting many denials from Humana Medicare Claims for CPT 00811 and also other Claims for CPT 00731

Been denied for
Remark Code: N19 - 'Procedure code incidental to primary procedure'
and
Claim Adj Codes: 97 - 'The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated'

*Humana Medicare is the only insurance
*CPT 45385 or 43235 were billed on same DOS (that was already paid by Humana Medicare) and also on a separate billed Claim
*CPT 00811 was billed with Modifier 'QZ' due to CRNA
*ICD 10 Codes were R10.9, K57.30, K63.5 and K62.1 for claim with CPT 00811
*ICD 10 Codes were T81.9XXA, R13.19 and T18.128A for claim with CPT 00731

What kind of modifier should be used to bill these Anesthesia if there is one?

 

[Lholt0522]

I am billing insurance with a modifier correction of QZ,PT for possible correction to issue.

 

[LisaAlonso23]

I have been getting many denials from Humana Medicare for CPT 00811 and CPT 00731

Been denied for
Remark Code: N19 - 'Procedure code incidental to primary procedure'
and
Claim Adj Codes: 97 - 'The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated'

*Humana Medicare is the only insurance
*CPT 45385 or 43235 were billed on same DOS (that was already paid by Humana Medicare) and also on a separate billed Claim
*CPT 00811 was billed with Modifier 'QZ' due to CRNA
*ICD 10 Codes were R10.9, K57.30, K63.5 and K62.1 for 00811
*ICD 10 Codes were T81.9XXA, R13.19 and T18.128A for 00731

What kind of modifier should be used to bill these Anesthesia if there is one?

When an EGD & colonoscopy are performed in the same encounter, the correct ASA code is 00813. You may not bill 00811 and 00731 together.

 

[Lholt0522]

When an EGD & colonoscopy are performed in the same encounter, the correct ASA code is 00813. You may not bill 00811 and 00731 together.

-That will come in handy one day I bet thank you! But no, the CPTs 00811 and 00731 were billed on different claims, they are just being denied the same way.