Anesthesia Coding Alert

Question: Our clearinghouse directs us to report surgical codes for our CRNAs, but the carriers are denying our claims because they need anesthesia codes. We've tried billing the anesthesia codes and including the surgical codes with a zero price as a reference, but the clearinghouse rejects them. What should we do?

Arizona Subscriber Answer: Start by speaking to someone at the clearinghouse about the options they can offer. Your clearinghouse needs to accept anesthesia codes because they are part of the accepted code sets. According to the ASA's Web site, "The Professional Claim Standard, known as the '837,' requires the 0XXXX (i.e., the anesthesia CPT 00100-01999) code on all transactions. If the payer needs the surgical code, that code must be supplied in addition to the anesthesia code. In the language of the 837 Implementation Guide, the surgical code is 'Required on claims where anesthesiology claims are being billed/reported if the provider knows the surgical code and knows the adjudication of the claim will depend on provision of the surgical code.' "

Most carriers now recognize the anesthesia codes and generally process claims without problems. They will occasionally hold anesthesia claims, however, until they receive the surgeon's claim to ensure that the anesthesia charge coincides with the surgical procedure.

The clearinghouse might reject your claims if you report both anesthesia and surgical codes as separate line items because this makes it look as if you're trying to bill two codes for the same service, even if you don't include a charge for the surgical code. Some coders recommend reporting the anesthesia code as a line-item charge and including the surgical code in Box 19 (the "reserved for local use" box) as further explanation.