Question General anesthesia for ASA code with MAC policy

cherylbr

Networker
Messages
55
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Good Afternoon,

Here is my questions:

Some of our anesthesia procedure, such as 01936, are provided under General anesthesia. We are using modifier AA or QK. We are NOT using the QS, G8, or G9 modifier as they are not applicable. Aetna Medicare is still rejecting these claims for the medically necessary MAC diagnosis code. Each time we have to call the carrier and explain that the anesthesia was under GENERAL and not MAC and that the MAC policy does not apply. I have spoken with a supervisor at Aetna/Medicare and they tell me that their system automatically reflects the MAC policy by the ASA code when processed. Has anyone else had this issue and how do you get these claims processed and paid on the first submission without going through having to call and review each and every one of them with a claims representative and explain to them that they were general anesthesia and not MAC and the MAC policy does not apply?

Would modifier 23 be acceptable in this case?

Any help would be greatly appreciated!

Thanks,
Cheryl B
 
Last edited:

TammyW

Networker
Messages
30
Location
Lindale, TX
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We have the same issue. And was given the same explanation. We add a diagnosis that supports medical necessity to every procedure listed in the MAC policy (if it's documented, of course). Doing this drastically cut our phone calls.
 
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