Question Medicare Rejection of 00731 CPT

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I need help...since 12/12/21 I am getting my CPT code 00731 (anesthesia for upper endoscopic procedures) rejected by Medicare. Explanation on EOB is saying due to an LCD determination- I looked up the L39063 also Article 858801 and it doesn't seem to apply. Nothing else in my regular billing has changed. Can someone help me out with this to see what changes took place that I am not aware of.
I am attaching an explanation of the remarks codes I am getting.
Thank you!
 

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LisaAlonso23

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Please provide more information regarding this case. In order to help you, I need:
  • anesthesia method
  • reason for procedure
  • procedural findings
  • procedure performed
  • co-morbidity diagnoses (if provided on anesthesia record)
  • what state the procedure was performed in
 
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This is just billing for anesthesia for procedure of endoscopy . k21.9, k22.70,k29.70. CPT 00731. CRNA performs the anesthesia. Modifier QZ and with P1, P2 or P3. I only do the separate anesthesia claim. Doctor does the one for procedure (CPT 43239) and facility their own as well. I also do colonoscopy (00811, 00812 ) and double anesthesia only (00813). I have been doing this for years and have never run into any problem except now for only the endoscopy. I am in Texas. Any help appreciated! Thanks!
 

LisaAlonso23

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This is just billing for anesthesia for procedure of endoscopy . k21.9, k22.70,k29.70. CPT 00731. CRNA performs the anesthesia. Modifier QZ and with P1, P2 or P3. I only do the separate anesthesia claim. Doctor does the one for procedure (CPT 43239) and facility their own as well. I also do colonoscopy (00811, 00812 ) and double anesthesia only (00813). I have been doing this for years and have never run into any problem except now for only the endoscopy. I am in Texas. Any help appreciated! Thanks!
Yes, I understand, but the information you provided was not enough to determine the anesthesia denial reason. What what the anesthesia method? Are there any co-morbidity diagnoses on the anesthesia record?
 
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MAC and no co-morbidity diagnosis. Sorry, thought I had answered this before. Just got another rejection today- same remark codes.
 

LisaAlonso23

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Sherman, TX
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Your coding should be:
43239/00731-QS-QZ
K22.70, K29.70

Novitas has an LCD for MAC anesthesia. You should have that list and add one of the diagnoses from that list if one is documented. This will justify the use of anesthesia.
 
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Dallas, TX
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Hello, we are receiving these denials as well since Dec 2021 but our cases are not MAC, no QS has been billed on any of them and we recvd 43 denials on one EOB for 00731 and 00732
 
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