# Anesthesia/Pain 63661 and 01936



## ChelseaNicole (Jul 23, 2014)

Any advice on the following issue would be greatly appreciated. 

I work for a pain management/anesthesia company.  They are under the same tax ID. Healthspring is denying our anesthesia claims but paying the pain claim for the same service. It seems that the pain claims are processing before our anesthesia claims they are receiving payment for the services but we are not. An example i was given was 63661 and 01936. Is there a modifier that we can attach to the anesthesia claims to have them process and pay? Thank you


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## Michele Hannon (Jul 23, 2014)

According to the NCCI edits: 01936 cannot be reported with 63661 for the same beneficiary on the same date of service; applies to Healthspring (a Medicare/Mediciad product).


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## dwaldman (Jul 23, 2014)

The NCCI edit between 01936 and 63661 is based on the code for anesthesia service included in the surgical procedure. The logic behind the edit is only that the physician performing the procedure can not also perform and bill for the anesthesia with such code as 01936.

What the NCCI edit does not apply to is: if one provider performs the procedure and a separate provider performs the anesthesia.

You need to write an appeal stating that the attached documentation shows that 2 separate providers were involved and payment should be allowed since the anesthesia was performed by a separate provider than the performing provider.

The only thing that came to mind was that you are only reporting 63661? Typically, permanent lead removal 63661 is accompanied by internal pulse generator removal (63688). If 63688 is also performed, I report 00300. 

I would review the report for permanent lead removal only?


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.  The physician performing a surgical or medical procedure should not report an epidural/subarachnoid injection (CPT codes 62310- 62319) or nerve block (CPT codes 64400-64530) for anesthesia for that procedure.  H.  HCPCS/CPT Procedure Code Definition  The HCPCS/CPT code descriptors of two codes are


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