# 01936 bundled with 72275



## 574coding (Jun 9, 2015)

Hello,
We have claims that will deny 01936 as bundled with 72275.  We have a CRNA that is providing the service 01936.  The CRNA is not being medically directed.  
The provider is performing the epidurography with other procedures and they will deny and not pay the CRNA claim.  
Why would the 72275 be bundled with an anesthesia code?  
Any Ideas on what we can do with our billing to receive reimbursement?


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## sfeinour (Jun 9, 2015)

*01936 with 72275*

Per NCCI edit:

"Code 01936 is a column 2 code for 72275, These codes cannot be billed together in any circumstances.
Code 01936 is bundled into code 72275 Code 01936 cannot be billed with 72275.
CCI edit Rule:
Anesthesia service included in surgical procedure *"


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## dwaldman (Jun 9, 2015)

01935 Anesthesia for percutaneous image guided procedures on the spine and spinal cord; diagnostic 

01936 Anesthesia for percutaneous image guided procedures on the spine and spinal cord; therapeutic 

The code listed n the question was 01936, which  is for anesthesia for a therapeutic procedure. CPT 72275 would represent a diagnostic procedure, it has the same edit that modifier is not allowed with 01935, but that edit is intended for at least from NCCI standpoint, for the same provider. Sometimes,  private payers that do not want to pay for both services will apply this even though two separate providers provided the service. You would need to appeal stating that the edit was applied incorrectly do to the fact separate providers provided the services.

http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html

Chapter 1 NCCI policy Manual 

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 6231062319) or nerve block (CPT codes 64400-64530) for anesthesia for that procedure.


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