Wiki Coding Auditor - surgical code

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sbottoms1

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I have recently started coding anesthesia and am getting denials for 00350 with surgical code 35301. Denial is incidental to primary procedure. Anyone familiar with this?
 
incidental to denial

That is a little unusual. Code 00350 is the correct ASA code for CPT 35301. Are you coding for both providers anesthesia and surgeon? Who is the insurance carrier? It almost seems that a call to the insurance may quickly resolve the problem. Though I do not have all the dynamics of this claim it is a little hard to point you in the right direction. If you would be able to provide a bit more information I may be able to assist you further. If you wish
 
The payer is Blue Cross of Illinois, and I am billing for the anesthesiologist. Sometime the phys is one of our own, so we are also sending those charges, and sometimes not. The surgical code is being pd for our phys, but I have been getting a lot of denials for the anestheiologists, all with the same denial reason-"this service is incidental to primary procedure code". I asked the claims specialist if these denials are new and was told that this has been happening for a while. I have not been very successful finding anything regarding anesthesia on their web site. The only thing I found was the formula for payment and the formula included the P status MF so have been adding that. I have thought about contacting the payer myself. Our claims specialist here usually do all the contact calls.
 
00350

Is the only code that you are submitting is 00350? If mutiple procedures performed that have different ASA codes then the highest base code is submitted. That really is about the only way you can get incident to denials. Except for pain managent services. Another topic for later. The next question is the NPI. I do not believe that an anesthesiologist would be able to perform such a serivce which leads me to believe that you must be a facility setting thus multiple physician claims may be submittted via HCFA 1500. Be sure that each provider is linked with there speciality and appropriate NPI. This will aid in payment assignment. You also need to be sure that it is being identified as a physician service and not facility charge (ther should be no RVU attached to the code). I hope I have helped. Good luck
 
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