Anesthesia Coding Alert

If you've compiled a list of your top-10 denials, comparing your top denial reasons with Medicare's will help you determine where you stand compared to other practices' most frequent denial reasons.

Try this: Check your Medicare carrier's own top-10 reasons for denying claims. And for a more hands-on approach, read our experts' views on how three of these issues crop up in anesthesia or pain management practices -- and what you can do about them.

Even the most conscientious coder might have details slip through the cracks and inadvertently submit a claim twice. How you handle the situation depends on exactly what happened and why.

"It might be a case of having two providers in the same specialty bill for the same service on the same day, such as an E/M service," says Jann Lienhard, CPC, a coder in New Jersey. "The carrier paid the physician whose claim reached them first, then denied the second."

What to do: Check both claims to be sure the diagnoses and specialties are identical, and then talk with your providers. Some might say to forget it (especially if you're dealing with an E/M service); if not, get the medical records and see if there is a difference between the claims you might be able to appeal.

Another scenario: Call the carrier to see when the original service was billed, by whom, and the resolution on the first billing. You might have submitted duplicate billing or resubmitted because the original submission was rejected for some reason.

Don't miss: The most important piece of information to gather is whether you received double reimbursement. If so, you must refund the money.

"Most anesthesia services are bundled" with other services, says Scott Groudine, MD, an anesthesiologist in Albany, N.Y. The anesthesia fee includes services such as:

What you can bill: The anesthesia service does not include some line placements, which means you can code separately when you have supporting documentation. These include:

"If providers do the coding, they know the basic coding but may not know how codes for services might be bundled," Lienhard says.

That's why your office needs checks and balances to be sure claims are correct.

Good example why: Your physician might provide a service bilaterally and include modifier 50 (Bilateral procedure) on the claim. Sometimes you should include the modifier, but appending it shouldn't be an automatic step. Some of CPT's codes represent bilateral services, which means you wouldn't report modifier 50.

Pain management coders see this with procedures such as kyphoplasty (22523-22525, Percutaneous vertebral augmentation, including cavity creation [fracture reduction and bone biopsy included when performed] using mechanical device, one vertebral body, unilateral or bilateral cannulation [e.g., kyphoplasty] ...).

"This is where provider and billing education come into play," Lienhard adds. "You can get resources that list codes you can report together and those you cannot. Every anesthesia and pain management coder needs these references."

Coming next month: Get the inside track on how to deal with three more common denial traps for your anesthesia or pain management practice, and learn which issues made the top-10 list of denials from a group of Medicare carriers.