Anesthesia Coding Alert

Question: We conduct prostate volume studies in the OR because we can give the patient anesthesia (usually MAC) for this painful procedure. Our Medicare carrier said the anesthesia is medically unnecessary and denied payment. How can we code?

Arizona Subscriber

Answer: Code 76873 (echography, transrectal; prostate volume study for brachytherapy treatment planning [separate procedure]) crosses to anesthesia code 01922 (anesthesia for non-invasive imaging or radiation therapy). However, some carriers might consider other codes appropriate crossovers for certain procedures, so check with your local carrier before filing 01922. Include documentation of the patients need for anesthesia, and get written information from your carrier on its reimbursement requirements. Also, consider having the patient sign a waiver before the procedure stating that the insurance carrier probably will not pay for the service, so the physician can bill the patient separately if the carrier denies payment.