Question Anesthesia Denial due to hospital transport

KRISIEFER

New
Messages
7
Best answers
0
We had a patient have a colonoscopy with anesthesia, and the gastroenterologist perfed the colon, which then required the patient to be transported to the hospital from the ASC. What is the proper way to bill the anesthesia for the colonoscopy in the ASC? I am not filing a modifier to "tell this detail" and the carrier has denied the claim b/c they have already paid the inpatient claim that was billed by another provider.

TIA for your help!
 

LisaAlonso23

Expert
Messages
419
Location
Sherman, TX
Best answers
0
Generally, patients are only allowed to be put under anesthesia once per day. Your case was prior to the hospital's, so it should be paid.

It needs to be appealed. First, I would make sure the coding is correct.
I don't have enough information to code the case entirely, but here's how I'd approach it.

453xx/0081x with the diagnosis for the procedure first. Then, a diagnosis with the finding followed by K91.71 (intraop accidental puncture, digestive system). *If the procedure was aborted due to the perforation, use code Z53.8 before K91.71.

In Box 19, I would note: PT REC'D TREATMENT AT ANOTHER FACILITY FOR PUNCTURE.
 

fwnewbie

True Blue
Messages
540
Location
New Haven, IN
Best answers
0
What kind of anesthesia was used for the scope? Conscious sedation is commonly used for these procedures while the hospital procedure was probably a general anesthetic with intubation.
Be sure you're coding for the correct type of anesthesia.
 
Top