Results 1 to 6 of 6

Thread: Help very new to anesthesia

  1. #1

    Default Help very new to anesthesia

    Promo: Code Books
    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.
    Anita Hudson, CPC
    Scott and White Bryan/College Station
    ajhudson@sw.org

  2. #2
    Join Date
    Apr 2007
    Location
    Chicopee, Mass
    Posts
    75

    Default Question

    Did the anesthesiologist actually perform the nerve block (01992)? If so, was it under anesthesia?

  3. #3

    Default

    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?
    Anita Hudson, CPC
    Scott and White Bryan/College Station
    ajhudson@sw.org

  4. #4

    Default 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

  5. #5

    Default 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

  6. #6
    Join Date
    Apr 2007
    Posts
    46

    Wink

    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....

Similar Threads

  1. New to anesthesia
    By MJCARRENO in forum Anesthesia
    Replies: 0
    Last Post: 03-05-2015, 09:38 AM
  2. Help with anesthesia billing for cancelled surgical cases - PRE anesthesia
    By gschues1 in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 09-12-2013, 03:28 PM
  3. Replies: 2
    Last Post: 02-13-2012, 08:11 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.