# Noridian Medicare Medical Necesity Denials



## missyah20 (Dec 26, 2012)

Good Afternoon,
  I have a couple of practices in Oregon where we have started to see Medicare Part B denials for anesthesia code 00142 (but also 00140, 01810, 01480) when billed with a QS modifier as "not medically necessary".  

  I called their provider customer service and the first rep told me that she couldn't find an LCD that included code 00142.  I agreed with her as LCD L24332 for Monitored Anesthesia Care doesn't include that anesthesia code.  She said she would research.

  I received a general message to call Noridian back which I did today and now another rep is telling me that they are denying this because it is billed with a QS and the Anesthesia Code 00142 isn't listed in the policy. 

  This doesn't make any sense to me and I am kind of at a loss as to how to continue pursuing these denials.  

  Has anyone else out there received denials such as this for Noridian Medicare?


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## missyah20 (Dec 28, 2012)

After hearing back from the Director of Noridian they are telling us that it was a system error that occured with the update on 12/10 and hopefully Noridian will have a release on this in the upcoming days.


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## Michele Hannon (Jan 4, 2013)

Noridian responds:

http://ooss.org/uncategorized/norid...ng-payment-for-cataract-monitored-anesthesia/


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## ceesh2009 (Jan 8, 2013)

*Medcr Denials*

For Medicare patients 

if MAC is used for eye surgery's(ie 00140 and 00142)  we code with AAQS -- when provider is MD  

or 

QZQS if provider is CRNA  - 


never QS alone --  always get paid


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## missyah20 (Jan 9, 2013)

They claims were billed with the appropriate anesthesia modifier (AA, QZ, etc) and then the QS and were still denied due this system update from Noridian.


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