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Anesthesia Coding Alert

Denial Dilemma:

Getting Denials for 01996? This Might Be Why

Published on Sun Sep 12, 2004

Knowing carriers' policies helps claims go through

If getting reimbursed for post-op pain management seems like a pain in itself, check that you're meeting the carrier's guidelines. Coding policies often include a section detailing reasons for denial, so being familiar with these lists can help ease your processing pain.
 
Empire of New York's policy regarding management of acute pain (including postoperative pain management) lists several reasons for denial that you can compare with your carrier's:

 

  • a claim submitted without a valid ICD-9 code (Empire's valid codes include 958.8, Other early complications of trauma; and V58.49, Other specified aftercare following surgery).
     
  • a claim for services rendered in a place of service other than ones the policy indicates are payable.
     
  • a claim that bills for daily management of epidural or subarachnoid drug administration (01996, Daily hospital management of epidural or subarachnoid continuous drug administration) on the same day as the catheter insertion.
     
  • a claim that reports 01996 more than once in a single day.
     
  • a claim for post-op pain management that lasts for more than three days without including documentation of medical necessity.
     
  • a claim that reports 01996 for more than one provider in a single day.
     
  • a claim that includes 01996 with either 01999 (Unlisted anesthesia procedure[s]) or 99499 (Unlisted evaluation and management service). Empire denies these claims because CPT includes specific codes for epidural analgesia, and Empire does not cover patient-controlled analgesia (PCA).
     
  • a claim that reports post-op pain management as an "incident-to" service. The attending anesthesiologist or CRNA must personally perform the service.

    "These are fairly standard reasons for denial, but sometimes coders aren't aware when carriers deny payments," says Cheryl Pascale, CCS, a coder with Hackensack Anesthesiology in Hackensack, N.J. "Always check your EOBs because you might be able to keep future errors from occurring."

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