Wiki H&Ps and Anesthesia

Create Wiki
L

LisaAlonso23

True Blue
Messages
775
Location
McKinney, TX
Best answers
0
Hi everyone,

I'm trying to explain to my providers why we may not bill 99201 with anesthesia CPT codes. I have provided the following link from NCCI:

http://www.aana.com/resources2/qual...-CPTcodes00000-01999_FINAL01012015_103114.pdf

I've explained that it's bundled into the anesthesia codes, but they are not convinced. They are claiming that they are providing H&Ps for podiatrists who are not medical doctors, so they should be able to bill 99201. In addition, the facilities require this of them.

The link above does state that 99201-99499 can be billed separately with a 59. When would this be acceptable bill? Did I miss something?

All insurance our office has spoken to has stated that this is unbundling. Does anyone have a reference for me to provide them?

I appreciate your help. Thanks!!
 
I think you're 100% correct here. Billing the E&M visit with a modifier to unbundle it from the anesthesia service would require that the service be documented as something distinct and separate from the anesthesia and surgery, such as visit to evaluate and treat a specific problem or concern that was unrelated to the podiatry issue. As the podiatrist presumably is the one making the decision for the surgery, billing an E&M service just for the hospital-required H&P with no other medical reason behind it would not be supported.

I can understand the providers' frustration if they are doing extra work for the podiatrists due to the hospital's requirements - I don't think it's a normal thing to have anesthesiologists doing H&Ps for another provider's patient. Perhaps they need to take this up with the hospital and/or the podiatry group to come to an arrangement. The hospital may have internists on staff that might be more appropriately used to perform required H&Ps. Alternatively, if the podiatrists are getting a pre-operative clearance from the patient's PCP, the hospital might be able to use the PCP's documentation to fulfill the necessary documentation requirements. Otherwise the podiatrists really should compensate them since they are collecting the global fee for which the E&M is a part. I think getting those parties together to work out a solution would be better than billing unnecessary E&M visits to payers and putting the practice at risk of an audit. Routinely billing E&M with anesthesia would almost certainly be noticed up by your payers and invite scrutiny.
 
You must log in or register to reply here.
Top