# Order of ICD 9



## cats2195 (Nov 8, 2011)

I am new to anesthesia coding and have a question in regards to the order of the ICD 9 codes.  We have had several claims denied for "not medically necessary".  The claims included ICD 9 codes justify the procedure but not the need for supervised anesthesia.  We are doing corrected claims but in what order do the ICD 9 codes need to be listed?  ICD 9 justifying the procedure first or ICD 9 for the anesthesia?

Thanks for your help!!


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## missyah20 (Nov 8, 2011)

The primary diagnosis should be the reason for the procedure. After that I would add any secondary diagnosis that help to support the need for a separate anesthesia provider.  

Make sure to check with your Medicare carrier and/or other insurance providers for any LCD's/medical policies that pertain to the denial to see what codes support this need.


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## cats2195 (Nov 9, 2011)

Would this apply to all Medicare.  We are particularly having issues with Trailblazer, Texas Medicare?


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## missyah20 (Nov 9, 2011)

I am assuming the denials are for Monitored Anesthesia Care.  Yes, Trailblazer Medicare (who is the Part B carrier for Texas) does have a MAC policy. Not all Medicare Carriers have MAC policies in place. 

Below is a link for their website.  It brings you to the page to seach for LCDs.  Just type in Monitored Anesthesia Care and it will bring you their LCD.

http://www.trailblazerhealth.com/Tools/LCDs.aspx?DomainID=1


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