Question Office based anesthesia services

bprieto

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Hello

Our office just started doing a bit of MAC in the office for HDR services, I am running into a bit of problems with insurance companies. We bill anesthesia codes with corresponding modifiers (AA,QS, and status modifiers, POS is 11, diagnosis used is the same as the one in the Op Note. Claim is being sent out under anesthesiologist information. What could I be doing wrong?

This is my first time ever billing for anesthesia services :(
 

enancy79

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Poplar Bluff, MO
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What is an example of your Anes code, Dx code, time units / minutes and modifier used? Payers have different guidelines. What does your most common rejection say?
 

bprieto

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We are using code 00400 and 00940 dx code are C61,C53.9 (PROSTATE CANCER, AND CERVICAL CANCER) my claim looks as follows

00940 AA,QS,P3 billed under anesthesiologist POS 11
 

enancy79

Networker
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Poplar Bluff, MO
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Your billing line appears correct. normally, one anesthesia code per procedure. What CPT code is being billing by the surgeon. It is possible they are bundling the anesthesia into that, or rejecting it as unnecessary. If these are Medicare claims, I'd check the LMRP for "Monitored Anesthesia Care" and make sure the medically necessary diagnosis is placed first on the patient's claim. I'm assuming the anesthesiologist's provider information is on file at the insurance (NPI, ID#, W-9 etc).
 

bprieto

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We are using CPT code 57155 you don't think it would an issue because of POS 11? We did call the insurance and they stated everything was wrong with the claim mod, DX. i believe the denial we have is for Amerigroup. What would be some of the medical necessary diagnosis for MAC?

OMG insurance company is now making me doubt myself :(
 

enancy79

Networker
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Poplar Bluff, MO
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I'm guessing but it looks like they don't want to pay a separate anesthesia provider for that CPT, especially if the surgeon is billing that CPT with a POS 11 and getting paid.

Amerigroup may have proprietary modifiers. Might ask them if their anesthesia billing policy guidelines are available online.

The anesthesia medical necessity codes are systemic diagnosis which justify that the condition of the patient warrants anesthesia. (ie, heart and lung conditions, diabetes, morbid obesity).
 
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