Wiki Anesthesia CPT 00811 and 00731- Denials

[Lholt0522]

I have been getting many denials from Humana Medicare Claims for CPT 00811 and also other Claims for CPT 00731

Been denied for
Remark Code: N19 - 'Procedure code incidental to primary procedure'
and
Claim Adj Codes: 97 - 'The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated'

*Humana Medicare is the only insurance
*CPT 45385 or 43235 were billed on same DOS (that was already paid by Humana Medicare) and also on a separate billed Claim
*CPT 00811 was billed with Modifier 'QZ' due to CRNA
*ICD 10 Codes were R10.9, K57.30, K63.5 and K62.1 for claim with CPT 00811
*ICD 10 Codes were T81.9XXA, R13.19 and T18.128A for claim with CPT 00731

What kind of modifier should be used to bill these Anesthesia if there is one?

 

[Lholt0522]

I am billing insurance with a modifier correction of QZ,PT for possible correction to issue.

 

[LisaAlonso23]

I have been getting many denials from Humana Medicare for CPT 00811 and CPT 00731

Been denied for
Remark Code: N19 - 'Procedure code incidental to primary procedure'
and
Claim Adj Codes: 97 - 'The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated'

*Humana Medicare is the only insurance
*CPT 45385 or 43235 were billed on same DOS (that was already paid by Humana Medicare) and also on a separate billed Claim
*CPT 00811 was billed with Modifier 'QZ' due to CRNA
*ICD 10 Codes were R10.9, K57.30, K63.5 and K62.1 for 00811
*ICD 10 Codes were T81.9XXA, R13.19 and T18.128A for 00731

What kind of modifier should be used to bill these Anesthesia if there is one?

When an EGD & colonoscopy are performed in the same encounter, the correct ASA code is 00813. You may not bill 00811 and 00731 together.

 

[Lholt0522]

When an EGD & colonoscopy are performed in the same encounter, the correct ASA code is 00813. You may not bill 00811 and 00731 together.

-That will come in handy one day I bet thank you! But no, the CPTs 00811 and 00731 were billed on different claims, they are just being denied the same way.

 

[smckee40]

I'm seeing a lot of denials from Humana Medicare regarding 00813. They paid but then came back and said they are taking it back due to "No Surgery Claim on file for anesthesia service." But they paid the claim that was for 45378 & 43239 done by the Gastro Clinic. Has anyone ever seen this before?

 

[LisaAlonso23]

-That will come in handy one day I bet thank you! But no, the CPTs 00811 and 00731 were billed on different claims, they are just being denied the same way.

There's not enough information to determine if the claims were coded correctly to cause denials.