Help very new to anesthesia

hudsondna

Networker
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44
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I have dr. A that performed 01992-for diag or therapeutic nerce block and injections. Then Dr. B performed 64480.
This claim was submitted to a Medicare replacement program. The problem I have is that the anesthesia claim was denied stating that the dx does not support medical necessary per the Medicare LCD. Regular Medicare pays this. What is the difference between Monitored anesthesia care and not. I hope this makes sence. If it does not I am sorry. I am very new to anesthesia. Thanks for any info.
 

hudsondna

Networker
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there are two dr in this pain management practice. when they do procedures one does the procedure and the other does the anesthsia. the dr that did the nerve block is not an anesthsiolgist. Does this help?
 

hgolfos

Guru
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Montgomery, Alabama
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Anesthesia and Pain management

Hey Anita,

I have seen this scenario before. One provider is giving the injection while the other is providing anesthesia for it. I'm not sure why the MC replacement program would deny for medical necessity if you are getting paid for the same procedures and dx with regular MC.

Some suggestions... check with the carrier, double check the claim and make sure you are filing 01992 as type of service 7 (anesthesia) with a HCPCS modifier (like AA) and time. Also, your carrier may want you to document any underlying conditions which cause the patient to require anesthesia for the procedure such as Alzheimers or mental retardation...

Hope this helps,

Heather G., CPC
 

kovacs

New
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Highland, IN
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kovacs

i always make sure there is an AA modifier for dr when using the 01992 (QZ for CRNA)and make sure you put in the start time and end time and physical status, we have a system that allows me to put in that this was MAC and not general.it should be paid. you might want to call to see if they need documentation, because pain management is anesthesia, they sometimes req additional information.
good luck
 

AYCPC

Networker
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Medicare does require a diagnosis that supports the use of MAC (typically HTN, etc). Also when you are billing the block use the modifier 59. That is how we bill for those in our office and we have no problem. Hope this helps....;)
 
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