Wiki Anesthesia for Colonoscopy denial

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missyah20

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Hello All,
I have an anesthesia provider based in Arkansas. We billed a colonoscopy with DX code V160 and anes code 00810. We received a denial from Medicare stating: "These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam." The anesthesia type was MAC, but I checked and Pinnacle Medicare does not have a MAC LCD.

I have only seen this denial for the actual colonoscopy not the anesthesia for the colonoscopy. Is there a way to appeal this? Or is this a denial that others have seen for the anesthesia for colonoscopy?

Any help or insight would be appreciated! Thanks!
 
Denial for 00180 Anesthesia

Was the place of service in the office? We have seen several codes denied because the procedure was performed in the office, not in an ASC. I have been trying to find something to clarify why the CRNA isn't being paid and the only clue I have found is where the procedure was considered to be a consious or moderate sedation level and that the payment to the surgeon was inclusive for the sedation. Apparently, there was no need for a separate person to administer or monitor the patient and could have been done by the performing surgeon.

The issue we are having is due to the use of deep sedation for procedures done in the office (POS 11) setting.

Can someone point me to a resource where this can be clarified?:confused:
 
Colonoscopy

I would be very careful with that V58.83 - bear in mind that the patient presented for a colonoscopy and not for the monitoring of any therapeutic medication - this would be considered misleading the insurance carrier. Sure, they will go ahead any pay it while they build their case against the provider.

The use of Propofol or any other medication for the purposes of sedating a patient in no way constitutes the reason for the encounter.

I think you need to rethink the application of this "V" code.
 
for our pennsylvania state centers, we append the V58.83 only if MAC was done on a medicare patient. This is not the primary diag of course but if we do not have this diag pa medicare will deny stating not medically necessary.

hope this helps!
 
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