Coding for MAC on facility bill

SarahSee1114

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Blue Springs, MO
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Hello! I'm working denials and I have a facility bill for MAC for a colonoscopy where the facility billed 01999, rev code 0370. I've reviewed other claims for a similar situation and they have billed without a CPT and only the rev code and it paid correctly. Anesthesiologist is billing 00812-QS. Can anyone help me understand if this facility is correct billing this way with the unlisted? Do they not bill the 00812 code also? Any help is appreciated!
 
Hello! I'm working denials and I have a facility bill for MAC for a colonoscopy where the facility billed 01999, rev code 0370. I've reviewed other claims for a similar situation and they have billed without a CPT and only the rev code and it paid correctly. Anesthesiologist is billing 00812-QS. Can anyone help me understand if this facility is correct billing this way with the unlisted? Do they not bill the 00812 code also? Any help is appreciated!
The facility and physician CPT codes for the same service should match, so one or the other of those is likely incorrect. However, facility claims are almost never reimbursed based on the anesthesia code. Outpatient surgical claims are usually paid at a case rate based on the surgery itself and all ancillary services items are inclusive to that rate. It is usual to see a CPT code included on revenue code 370, but my guess is that this is not going to make any difference at all in the final payment of the claim.
 
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