Wiki Cpt 36475

[iahamed@clinicanywhere.com]

My provider specialty is Anesthesiology-Pain Medicine. We are billing CPT 36475 to the BCBS IL, but they are denying it because an anesthesia provider must use the actual anesthesia code and not the code for the procedure the anesthesia is being provided for. - Could you kindly advise if we need to bill 36475 along with any other procedure?

 

[LisaAlonso23]

If you're coding/billing anesthesia, you need the ASA Crosswalk. You look up the procedure the surgeon performed in the Crosswalk, and it will tell you which anesthesia code to use. The surgeon performed 36475, so it is not appropriate for you to bill it for an anesthesia provider. The anesthesia provider only provides anesthesia services for this procedure, so your coding needs to indicate that.

36475 crosswalks to 01930, so you should bill out 01930 with the appropriate modifier (AA, QY, QZ, etc.)