ASC Propofol reimbursement?

FUTURE09

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I'm billing for a anesthesiologist for Pain Management procedures and receiving BCBSM rejections. I am including the name and the dosage in code 19 and listing the proper minutes on the 1500 claim form. Should I be utilizing the P1-P5 status modifiers? Is anyone else having this issue? Looking forward to any input out there!! :confused:
 

lch

Networker
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Nashville, TN
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I am new to Pain Management and need to bill Propofol with some procedures that were done in our ASC last week - I see it's an unlisted code.. do any of the payers pay for it?

Thanks!
 

aaron.lucas

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Cherry Hill, NJ
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FUTURE: What's the denial you're getting? Is there an EOB that tells you why they're denying? Some payers do require modifiers, so it could be that, and not necessarily P1-P5, could be they're looking for an AA, QS, etc. Other than that if you gave the drug, dosage, and time spent it should be enough.
 

FUTURE09

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Morning,
I am receiving BCBS rejection stating "NOC procedure reported w/o description of service". I am billing either 01992 or 01936 with J3490, listing "propofol XXmg" on code 19. Another rejection I just recieved this morning was the propofol was inclusive with another procedure same day? Are you experiencing such rejections? I would have an ASC facility could bill the CPT code along with the drug used to sedate the patient would be covered. I'm very frustrated.
 

aaron.lucas

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Interesting, maybe they're wanting more documentation to explain the unlisted drug code? Also are you billing for a physician or the facility? In my experience (NJ PIP), ASC's are paid by groupers similar to Medicare groups, although there are fewer groups in NJ, and there are several things included in the facility fees, two of which are anesthesia services and drugs. If you are billing for a facility it may be the BCBS is saying that those things are included in the facility fee for the procedure. If it's for a physician, then maybe they are looking for more information regarding the unlisted drug code, and possibly a modifier on the anesthesia code. does that help at all?
 

FUTURE09

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Yes that backs up what I thought! I just don't understand why, when billing from an Anesthesia Group, that the Propofol wouldn't be an expected charge. Meaning, why would additional documentation be needed when the name and the dosage is listed. But that's the fun of being a biller, right! :) Thanks so much for your input. Enjoy you day!
 
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