Anesthesia Coding Alert

Question: We’re receiving denials from one payer that says Medicare doesn’t 01936. Does Medicare reimburse for 01936?

West Virginia Subscriber

Answer: The Medicare Physician Fee Schedule (PFS) appends status code "J" for code 01936 (Anesthesia for percutaneous image guided procedures on the spine and spinal cord; therapeutic).

Description: The explanation of "J" status is as follows: "Anesthesia Services. There are no RVUs and no payment amounts for these codes. The intent of this value is to facilitate the identification of anesthesia services."

Remember: Anesthesia codes (ASA codes) are not paid based on the Medicare PFS. Instead, anesthesia code payment is regulated by the Anesthesia Fee Schedule and payment formula. The payment formula includes figures based on the geographic location where the service was provided, the code’s base unit value (which is 5 units for 01936), and the amount of time the anesthesia provider spends during the case.

The payer should reimburse for anesthesia services that fall under 01936. Verify that 01936 is the correct anesthesia code for the surgical procedure performed. Legitimate possibilities include 22520 (Percutaneous vertebroplasty [bone biopsy included when performed], 1 vertebral body, unilateral or bilateral injection; thoracic), 22526 (Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level), 62292 (Injection procedure for chemonucleolysis, including discography, intervertebral disc, single or multiple levels, lumbar), among others. If you’re certain that 01936 is the correct anesthesia code, you might need to submit a hard copy claim with documentation before getting paid.