Wiki Noridian Medicare Medical Necesity Denials

[missyah20]

Good Afternoon,
I have a couple of practices in Oregon where we have started to see Medicare Part B denials for anesthesia code 00142 (but also 00140, 01810, 01480) when billed with a QS modifier as "not medically necessary".

I called their provider customer service and the first rep told me that she couldn't find an LCD that included code 00142. I agreed with her as LCD L24332 for Monitored Anesthesia Care doesn't include that anesthesia code. She said she would research.

I received a general message to call Noridian back which I did today and now another rep is telling me that they are denying this because it is billed with a QS and the Anesthesia Code 00142 isn't listed in the policy.

This doesn't make any sense to me and I am kind of at a loss as to how to continue pursuing these denials.

Has anyone else out there received denials such as this for Noridian Medicare?

 

[missyah20]

After hearing back from the Director of Noridian they are telling us that it was a system error that occured with the update on 12/10 and hopefully Noridian will have a release on this in the upcoming days.

 

[Michele Hannon]

Noridian responds:

http://ooss.org/uncategorized/norid...ng-payment-for-cataract-monitored-anesthesia/

 

[ceesh2009]

Medcr Denials

For Medicare patients

if MAC is used for eye surgery's(ie 00140 and 00142) we code with AAQS -- when provider is MD

or

QZQS if provider is CRNA -


never QS alone -- always get paid

 

[missyah20]

They claims were billed with the appropriate anesthesia modifier (AA, QZ, etc) and then the QS and were still denied due this system update from Noridian.