Anesthesia Coding Alert

Watch these 3 areas to help ensure clean anesthesia claims 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. Last month's Anesthesia & Pain Management Coding Alert looked at three denial-prone areas for anesthesia practices: improperly bundled services, duplicate claim submissions, and misused modifiers. Now our experts share their views on three more issues that crop up in anesthesia or pain management practices, and how you can conquer them. Try this: Check your Medicare carrier's own top-10 reasons for denying claims, or check the box on page 19 for the top-10 reasons for denials nationally. 1. Watch for Subtleties of Mismatched Diagnoses Reporting the correct diagnosis for a procedure is just as important as correctly coding the procedure itself. Some procedures have "flags" and a list of approved diagnoses, says Jann Lienhard, CPC, a coder in New Jersey. If the payer doesn't believe your diagnosis supports medical necessity of the procedure, the payer will deny your claim. Watch for these common diagnosis mistakes in your coding: • Not updating a pain management patient's diagnosis. For example, administering an epidural or blocks with a vague diagnosis such as "back pain" can result in quick denials. • Changes in an obstetric patient's status. For example, an expectant mom comes to the hospital in labor. After 14 hours, her labor stops and she returns home. She returns three days later and delivers. The payer will deny your claim if you report both cases with 01967 (Neuraxial labor analgesia/anesthesia for planned vaginal delivery [this includes any repeat subarachnoid needle placement and drug injection and/or any necessary replacement of an epidural catheter during labor]) with diagnosis 650 (Normal delivery). • An incorrect diagnosis for post-op pain management. Many payers have specific guidelines for the diagnoses they consider acceptable for postoperative pain management, says Scott Groudine, MD, an anesthesiologist in Albany, N.Y. Empire in New York, for example, lists only three diagnoses to justify 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration) and epidural codes 62310-62319. Empire accepts 338.11 (Acute pain due to trauma), 338.12 (Acute post-thoracotomy pain) and 338.18 (Other acute postoperative pain). Because of these types of stipulations, always verify your payer's policy for post-op pain management. Helpful: Some mistakes can be a simple matter of keying the wrong diagnosis, Lienhard says. If you receive a diagnosis-based denial, verify that you didn't submit a claim with a typo. If the diagnosis you submitted was correct but isn't on the payer's list, talk with your physician. A secondary diagnosis he documented might work just as well. 2. Try This Routine [...]