taburton87
New
Greetings!
I was wondering if anyone has had any issue getting Medicare to pay CPT 01953 with or without a modifier?
Our office has had ongoing issues for quite some time now, getting this code paid in a number of different scenarios. These claims are being stopped up front via Medicare's SMART EDIT, so they can't even get out the door for processing.
Typically, we see that Medicare will pay the 01952 with the modifier AA, QX or QK (most of our burn cases end up with these specific modifiers, due to the nature of the visit and who is performing the anesthesia service at the time), however, Medicare still refuses to pay the add-on code 01953. Our coders have tried a few "test patients" where we would either remove the modifier on the add-on line or change the modifier to a -59, -78, or -79 (depending on the case) just to see if the claim would bypass the SMART EDIT and go out the door, but so far, nothing. The SMART EDIT continues to flag the add-on code for modifier issue, no matter what we use. We are at a lost...
Can anyone shed some light as to what may be going on with the Anesthesia add-on burn codes for Medicare?
Has anyone had any success getting CPT 01953 paid?
Appreciate the insight!
Tiffany
I was wondering if anyone has had any issue getting Medicare to pay CPT 01953 with or without a modifier?
Our office has had ongoing issues for quite some time now, getting this code paid in a number of different scenarios. These claims are being stopped up front via Medicare's SMART EDIT, so they can't even get out the door for processing.
Typically, we see that Medicare will pay the 01952 with the modifier AA, QX or QK (most of our burn cases end up with these specific modifiers, due to the nature of the visit and who is performing the anesthesia service at the time), however, Medicare still refuses to pay the add-on code 01953. Our coders have tried a few "test patients" where we would either remove the modifier on the add-on line or change the modifier to a -59, -78, or -79 (depending on the case) just to see if the claim would bypass the SMART EDIT and go out the door, but so far, nothing. The SMART EDIT continues to flag the add-on code for modifier issue, no matter what we use. We are at a lost...
Can anyone shed some light as to what may be going on with the Anesthesia add-on burn codes for Medicare?
Has anyone had any success getting CPT 01953 paid?
Appreciate the insight!
Tiffany