I work disputes for a Medicaid/Medicare managed care company. Does anyone know if Medi-cal allows or requires anesthesia groups to report the anesthesiologist service and the CRNA service on the same claim? It seems odd to me that this would occur as often as it does, but it is somewhat common.
I found this for Medi-cal:
"Medi-Cal policy prohibits payment for duplicate services and/or billings. The second and subsequent claims for anesthesia services billed for the same date of service, the same recipient and the same procedure submitted by the same or different providers will be denied with RAD code 328, 'Another procedure with an anesthesia modifier has been previously paid for the same recipient on the same date of service'."
If you're billing the CRNA services under the anesthesiologist's name, and the anesthesiologist is billing for the same service under his/her name, that will hit this denial it appears. I assume that's the reason they are wanting both on the same claim.