Wiki Appeals Being Upheld

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alexis.nichole13@hotmail.com

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Loogootee, IN
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I have MHS Medicaid denying anesthesia claims when I bill a "QZ" modifier and a physical status modifier. We have a CRNA that performs our anesthesia procedures, therefore we always bill with a QZ modifier. I have sent multiple appeals on this matter stating that we have to bill those modifiers. They are still upholding their original decision (denial). They can not tell me what modifier they want me to bill either. I am needing some opinions on this.

Thank you,

Alexis I., CPC
 
What are the specific denial codes and wording they are using? And what codes (procedure and dx) are you using? and what place of service?

Which state? (there is more than one MHS Medicaid).

What I am seeing is they don't accept QZ modifier, and CRNA claims should be billed with a QS modifier.
 
CPT code 01810 is a big one that they are denying with the modifiers. The denial states "Modifier billed is not valid, please resubmit with correct code"
Place of service is an Ambulatory Surgical Center
State is Indiana
We always bill a QZ modifier on all of our anesthesia codes as our CRNA performs these services without medical direction from a physician.
 
QS - Monitored anesthesiology care services (can be billed by a qualified nonphysician anesthetist or a physician).

MHS Medicaid does not recognize QZ, and it is not going to be paid with QZ. All of the times I have found where someone asked this question, the answer was always "use QS".
 
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