Anesthesia Coding Alert

Question: Several of our payers (private and Medicare) are denying claims with 01996 due to “invalid/missing modifier” based on Novartis guidelines. We’ve searched the Novartis website but haven’t found documentation of this. What could be wrong?

Texas Subscriber

Answer: You could be dealing with an incorrect denial. Payers are accustomed to seeing provider modifiers on anesthesia claims (such as AA, Anesthesia services performed personally by anesthesiologist). Code 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration), however, does not always need a modifier. Appeal the claim, stating that no modifier is required. If the claim is still denied, contact your local payer representatives for an explanation.