# Anesthesia bundled with surgery?



## beachgrl62 (Oct 15, 2012)

I billed a 01400 as the anesthesia code for an ACL knee repair (29888). The insurance has denied, stating these are bundled. Since when? 3M states this is the correct code for this procedure. Has anyone else had this issue?


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## twizzle (Oct 15, 2012)

Anesthesia cannot be bundled with surgery.


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## mcnaryk (Oct 15, 2012)

beachgrl62 said:


> I billed a 01400 as the anesthesia code for an ACL knee repair (29888). The insurance has denied, stating these are bundled. Since when? 3M states this is the correct code for this procedure. Has anyone else had this issue?



That has to be an insurance error-OR, the patient does not have coverage for anesthesia (I've seen that on smaller/cheaper individual plans). I'd appeal it, and make sure you appended your AA/QX/QY modifier to the 01400 as applicable. Let us know what happens!


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## dwaldman (Oct 17, 2012)

G. Anesthesia Service Included in the Surgical Procedure
Under the CMS Anesthesia Rules, with limited exceptions, Medicare does not allow separate payment for anesthesia services performed by the physician who also furnishes the medical or surgical service. In this case, payment for the anesthesia service is included in the payment for the medical or surgical procedure. For example, separate payment is not allowed for the physician's performance of local, regional, or most other anesthesia including nerve blocks if the physician also performs the medical or surgical procedure. However, Medicare allows separate reporting for moderate conscious sedation services (CPT codes 99143-99145) when provided by same physician performing a medical or surgical procedure except for those procedures listed in Appendix G of the CPT Manual.
CPT codes describing anesthesia services (00100-01999) or services that are bundled into anesthesia should not be reported in addition to the surgical or medical procedure requiring the anesthesia services if performed by the same physician. Examples of improperly reported services that are bundled into the anesthesia service when anesthesia is provided by the physician performing the medical or surgical procedure include introduction of needle or intracatheter into a vein (CPT code 36000), venipuncture (CPT code 36410), intravenous infusion/injection (CPT codes 96360-96368, 96374-96376) or cardiac assessment (e.g., CPT codes 93000-93010, 93040-93042). However, if these services are not related to the delivery of an anesthetic agent, or are not an inherent component of the procedure or global service, they may be reported separately.
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29888  KNEE ARTHROSCOPY/SURGERY M  Total Facility RVU: 29.13   


01400  ANESTH KNEE JOINT SURGERY M  Total Facility RVU: 0.00   


Code 01400 is a component of Column 1 code 29888 and cannot be billed using any modifier. 

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Another thing to consider is the carrier is taking NCCI edits and using them but not making the appropriate exclusions as Medicare follows. I would appeal in writing stating, that you are aware of the NCCI code pair of 29888 and 01400 with  modifier not allowed. But this applies only to the surgeon performing the surgical procedure. The anesthesia provider should be allowed separate payment because they are not performing the surgical service nor are they being paid for the surgical service. I would quote the amount time the procedure took and state that the anesthesia provider spent the allotted time providing anesthesia so the patient could have ACL repair and that this should be covered under their plan.


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## alk@APS (Oct 24, 2012)

Was this Humana because I had the same thing happen recently with Humana


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## ambonham (Jul 11, 2014)

*Anesthesia*

I am in taking the coding course right now through the AAPC, and in the "Anesthesia" chapter.  My understanding from the CPT is that anesthesia codes are reported only by the anesthesia providers.  They are a section all their own.   There are exceptions to this that, according to my text book, that require modifier "47" - Anesthesia by surgeon. "This modifier reported by the surgeon when he also provides regional or general anesthesia for the surgical service, and does not apply to local anesthesia.   This modifier is not to be reported with anesthesia procedure codes.  Anesthesia providers do not report this modifier."
I am new to this and enjoy learning from the networking.   I hope this helps.


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