Anesthesia Coding Alert

Know when and how to rely on this tool ‧‧ but don't expect to always get paid         When your anesthesiologist or pain management specialist performs a service Medicare doesn't usually reimburse, don't assume it's an automatic write-off. Keep an eye out for these potential roadblocks and file an advance beneficiary notice (ABN) up-front to switch the odds in your favor.       What it is: An ABN is a written notice that informs the beneficiary (that is, the patient) that Medicare might not cover a particular service or procedure. Signing the waiver shows that the patient acknowledges he may have to pay for the procedure or service if Medicare does not -- if you document his treatment correctly, says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, CodeRyte Inc. coding analyst and coding review teacher.   Why Won't Medicare Pay?         If Medicare doesn't pay for a service your physician offers, the reason usually falls into one of two categories:       • procedures that exceed Medicare's frequency guidelines       • procedures that Medicare doesn't ever reimburse.         To further confuse matters, you might run into situations when Medicare usually covers a service but considers it noncovered in other situations -- which means you would need an ABN.       Over-the-limit procedures: Medicare only allows for a finite number of certain procedures per patient per time period. For example, Florida's Medicare carrier allows a repeat injection in the sacroiliac joint only if the first two injections relieved the patient's symptoms, says Myriam Nieves, CPC, ACS-PM, owner of Precision Medical Systems in Ft. Lauderdale, Fla. "Otherwise, the probability of the third injection providing relief is way too slim," she says. "They allow a maximum of three injections per year."       Never-reimbursed procedures: Medicare simply doesn't cover some procedures, such as intradiscal electrothermal annuloplasty, or IDET (22526, Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level; and +22527, ... one or more additional levels [list separately in addition to code for primary procedure]). Although CPT 2007 includes new codes for IDET, Florida Medicare still considers IDET an experimental or investigational procedure, Nieves says. In these cases, you won't need a signed notification unless a secondary insurer is willing to pay.       Gray-area procedures: Medicare reimburses for other procedures on a situational basis ‧‧ your physician might perform a service that Medicare covers in some instances but not in others. For example, Medicare reimburses for Hyalgan injections to the knee, but physicians might also administer Hyalgan injections to the shoulder because they've seen patients benefit from the treatment, Nieves says. "Because they are not using the product as indicated, this is a service that is covered under other circumstances but [...]