Erector Spinae Nerve Block Medicare Denial

missyah20

Guru
Messages
219
Location
Minneapolis
Best answers
0
Good Afternoon,

We received a denial from Medicare for a CRNA performed Erector Spinae block billed with code 64999. The redetermination letter states that they are denying this as they do not consider the providers current qualifications as a CRNA to be sufficient to provide the service and there is no evidence to support the practitioner has undergone training to be able to provide the service in this state. The state this was performed in is Arkansas.

Does anyone have any suggestions on what I can do from here? BON state scope of practice are usually pretty vague and I don't know if that would be enough to satisfy Medicare.
 

LisaAlonso23

Expert
Messages
294
Location
Sherman, TX
Best answers
0
Good Afternoon,

We received a denial from Medicare for a CRNA performed Erector Spinae block billed with code 64999. The redetermination letter states that they are denying this as they do not consider the providers current qualifications as a CRNA to be sufficient to provide the service and there is no evidence to support the practitioner has undergone training to be able to provide the service in this state. The state this was performed in is Arkansas.

Does anyone have any suggestions on what I can do from here? BON state scope of practice are usually pretty vague and I don't know if that would be enough to satisfy Medicare.
Have you submitted claims for nerve blocks performed by a CRNA to Medicare before or is this the first time?
 

danachock

Guru
Messages
198
Location
Brainerd, MN
Best answers
0
Hi Missyah20 ,
I apologize for all of my questions but was the Eractor Spinae Block for post operative pain management? If so - was the necessary modifier applied with proper diagnosis codes? 64999 is an unlisted code ~ did AR actually send the appropriate documentation with the claim to support billing this unlisted code?
Also back in the day working anesthesia denials I once in while received something odd about an EOB and would call and inquire to a different state other than ours and ask about the denial to find out "that their fee schedule because of such modifier would not allow payment for a certain procedure to be performed".
What were the actual adjustment codes applied on your denial? Please list all of them. Typically I found it wasn't always the first one listed providing the necessary information to correct the claim or appeal.
Personally if it was me I would find out what your PTAN number is (due to Medicare) for your provider and call Medicare "personally" to find out what the deal is with denying this claim. If you have never done this before ~ please reach out to your AR/billing team and simply ask for help with an explanation.
The reason why I state that you should actually personally make the telephone call is because there are "NUMEROUS" times I have called to inquire and have been told ~ "well if coding had done this or that ....." and when I can actually state that "well, I am actually the coder and reviewed this and it is billed correctly" and need to have an explanation on why the claim was actually denied by them ..... I somehow received the answers. To me, this really simply eliminates the (AR/Coding) run around that can turn out to be quite lengthy for receiving reimbursement and very time consuming (hmm ~sometimes almost timely).
Hopefully I can provide a few issues to review. Do not be afraid to step in and make that call to Medicare. My two cents is open the electronic EOB with patient DOB and Member # and you have this. They really are super patient to help. Just relax and find the information to provide and simply explain the issue.
I wish you lots of luck resolving this!
Dana Chock, RHIT, CPC, CANPC, CHONC, CPMA, CPB
Coding Analyst (May 2018-present), Anesthesia, Pathology, Laboratory Coder (Fall 2012-May 2018)
 
Last edited:
Top