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Wiki telehealth

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sdb67

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Hi - I have a provider that is billing Anesthesia services as telehealth? Anyone else have this happening - code 00811
thank you
 
How...would that even be possible? I'm sorry I don't have an answer for you but I'm really curious to see who does!

ETA: I need to ask: Is there any chance that doctor regularly bills a very similar code where this could be a typo or just a data entry error with the wrong POS code selected? Or is this happening on a regular basis?
 
trarut said:
How...would that even be possible? I'm sorry I don't have an answer for you but I'm really curious to see who does!

ETA: I need to ask: Is there any chance that doctor regularly bills a very similar code where this could be a typo or just a data entry error with the wrong POS code selected? Or is this happening on a regular basis?
Click to expand...
That was my reaction - there are several claims for various members billed with codes like 00812, 00811, 00731 with a SG modifier. These were paid because the payer didn't look at the POS and stated that it wasn't standard to review POS when adjudicating a claim. I just had no words for that - but thought I'd see if anyone else was seeing anything like this or knew of payers who didn't take the POS into consideration when adjudicating a claim.
 
sdb67 said:
Hi - I have a provider that is billing Anesthesia services as telehealth? Anyone else have this happening - code 00811
thank you
Click to expand...
You can't code 00811 for telehealth, as that's not physically possible.

If the provider is performing the H&P via telehealth prior to anesthesia services, it is not separately billable as the H&P is bundled into the ASA code regardless of how it's performed (ie, in-person, via telephone, or via telehealth).
 
sdb67 said:
That was my reaction - there are several claims for various members billed with codes like 00812, 00811, 00731 with a SG modifier. These were paid because the payer didn't look at the POS and stated that it wasn't standard to review POS when adjudicating a claim. I just had no words for that - but thought I'd see if anyone else was seeing anything like this or knew of payers who didn't take the POS into consideration when adjudicating a claim.
Click to expand...
I find it hard to believe they don't have a front-end edit to compare the service code to the POS. They (generally speaking) certainly do it for E/M codes so we know they can.

Payers - as organizations, not the folks actually doing the work - are weird ducks. I liken it to having to provide a diagnosis to obtain an authorization but then the payer denies the claim for authorization/medical necessity and tell us that they don't review for medical necessity until they receive the claim. So why precisely do we have to provide a diagnosis code and supporting records with the auth request if you aren't going to validate at that point? But I digress - that's a topic for another day and another thread ;)
 
I'm sorry, I laughed.

Unfortunately the payer has the luxury of making mistakes and still requiring the provider to return the money. But I'm not sure a POS edit would have caught the error. Did the provider use 02 or 10?
 
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