Wiki Help needed for Anesthesia billing

[jdibble]

I did post this on another thread but decided to also post this here as there is an urgency in getting this issue answered as soon as possilbe! So please forgive me if you have seen this question before... If someone could help me understand this Anesthesia coding I would be greatful! WE have just starting sending out our first round of Anesthisia claims so we are not too sure of what we are doing. I had a patient who had an epidural for a vaginal delivery. We billed Aetna and they are denying the claim (per the Aetna website) stating the following:

F2 Finalized/Denial-The claim/line has been denied.

Claim Status Claim Status Description

121 Service line number greater than maximum allowable for payer

The patient was given an epidural - start time was 11:15 and stop time was 13:45. We billed code 01967-P1-AA 15 units (5 base units plus 10 units for time.) The claim did include the times.

Can someone please help? We have sent out so many claims in the last few weeks and now I am worried that they are all wrong and this is only the beginning of the denials!!

Thanks in advance for help!
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[mistygirl]

Hello jdibble.

You billed that correctly, it is the correct amount of units based on the time, and you used the correct code... Not sure why Aetna would deny it, you billed it correctly

I have been billing and coding anesthesia/pain mgmt. for over 15 years, it will get easier, don't be overwhelmed by it. It's always fixable.

I'm probably too late to help you, but I wanted to try anyway

 

[ivorytofu@hotmail.com]

Some carriers are not paying times/units for epidurals but are paying a flat rate instead. I would call the carrier and find out what their policy is for delivery epidurals.

Anastacia Sims, CPC