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billing CRNA for medicaid

fyarbo03

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I need help. I am currently a medicaid rep, due to trouble finding a coding position. But we are having trouble with the CRNA coding.
this is what we keep getting.
00740 ANESTHESIA FOR UPPER GASTROIN - denial code 1887 (COMBINE CHARGES AND REBILL USING MAJOR ANESTHESIA CODE. INDICATE TOTAL TIME (UNITS) IN COLUMN G. FILE ADJUSMENT OF PREVIOUSLY PAID CLAIM IF NECESSARY.

00810 ANESTHESIA FOR LOWER INTESTIN - denial code 1888 (ONE ANESTHESIA PROCEDURE ALLOWED PER SAME DATE OF SERVICE

This two codes are together for the same patient. Do we combine units and cost into one of the two codes? or do we just adjust off one and only bill for one?
 

hewitt

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Manhattan, NY
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There really is not a "short answer" to your question. I can tell you how to code for this instance, but your question triggers in my thinking that you have other more basic coding issue. I think it would be wise for you to purchase an Anesthesia Coding Companion or other reference. Sorry.
 

aaron.lucas

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286
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Cherry Hill, NJ
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you would use whichever anesthesia code corresponds to the "primary procedure" (usually the one with the higher RVU) and bill that one code for the whole thing (count all the time and units under that one code). by the wording of their denials, it would lead me to believe 00740, and use all the time for that code. also, you're including the modifier for the CRNA, correct?
 

hgolfos

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Montgomery, Alabama
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I agree, for anesthesia, regardless of provider, you can't bill two ASA codes for the same operative session. If the colonoscopy and EGD mentioned above were done in the same session you bill one or the other. In this case both procedures have the same base units so choose the one you have the most specific diagnosis for, and bill the total time for both procedures. For Medicaid in our state you have to append the CRNA anesthesia modifier. QX for Medically directed and QZ for non-medically directed.

If these are being done at different operative sessions during the day you can try appending a 59 modifier to the second procedure.
 

fyarbo03

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we are using appropriate modifiers. for example, one code has 28 units and one code has 5 units. Do i combine those units for those two codes?
 

hgolfos

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Montgomery, Alabama
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Neither of the codes you mentioned has base units of 28. The two highest base units in ASA are 25 and 30 and they are for open heart and liver transplants respectively.

00740 = 5 base units

00810 = 5 base units

You cannot bill for the base units of both codes. You choose one code, base units 5 then add the time units for the entire operative session.

Anesthesia formula

(BASE + TIME + PHYSICAL STATUS / CLINICAL CIRCUMSTANCE) x RATE = CHARGED AMOUNT

You can find all of this information in the ASA's Relative Value Guide, published and updated every year. If you don't have one of these I highly recommend getting one.
 

fyarbo03

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i think the 28 units for 1 code is what they call minutes in this hospital? Not sure. So should I still not combine "units" or charges into 1 code?
 

hgolfos

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Montgomery, Alabama
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Base units (for ONE code) time units for whole session, bill only one code. Medicare requires that you report time units in 15 minute increments. So, for 28 minutes you would report 2 units. Commercial insurances typically accept 10 minute increments so for 28 minutes you would report 3 units. Check with Medicaid to see how they want time reported. Some want actual minutes and some want units. ALWAYS only bill one code's base units.
 
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