Anesthesia Denied "Incidental" to 64472 & 64470

jsolares

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Hello,

I am reviewing an insurance explanation of benefits which denied the anesthesia service CPT 01991, AA as "incidental" to another provider's claim-for CPT 64472 and 64470.
I don't see anything listed under CCI Edits. Can CPT 01991 be appealed with a modifier?
 

jdrueppel

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If the anesthesia was performed by a different provider, different specialty a modifier should not be necessary. Most likely, this is just an incorrect adjudication edit within the payers claims payment system. If this is same specialty, same group it may be that both claims have the same group provider number and/or NPI causing the denial which may require a modifier to show separately identifible service, if Medicare may require -59 modifier. If not adding a modifier I'd appeal noting separate provider performing anesthesia service and, if available, Operative Report which hopefully notes medical necessity of anesthesia.

Julie, CPC
 
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