Anesthesia Coding Alert

Question: Our non-medically directed CRNA often provides the anesthesia service (01936) while the physician performs the epidurography with other procedures. Some of our payers deny 01936 with 72275 and not pay the CRNA claim. Why would the 72275 be bundled with an anesthesia code? How do we code to receive reimbursement? 

Arizona Subscriber

Answer: CCI (Correct Coding Initiative) bundles code 01936 (Anesthesia for percutaneous image guided procedures on the spine and spinal cord; therapeutic) as a Column 2 code under 72275 (Epidurography, radiological supervision and interpretation), with a modifier indicator of “0.” This means you cannot break the bundling in any circumstance and bill both codes. 

You need to verify who is performing the epidurography before filing the claim.

If it’s being performed by the physician, you create two claims: one with 72275 for the physician and one with 01936-QZ (CRNA service: without medical direction by a physician) for the CRNA. Submit the respective claims under each individual’s NPI. 

If the payer continues to deny the separate claims due to CCI edits, appeal with two fresh claims and resubmit with clear documentation of who performed each service. Specify that two different providers with individual and separate NIP numbers performed two separate procedures (one of which was anesthesia). 

If either provider performs both procedures, you cannot bill 01936 with 72275. Simply report code 72275.