Wiki How to get 00810 and 00740 paid?!?!

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vanessa10

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We are getting denials for asa codes 00810 and 00740 from Blue Cross! Is there a trick to getting these paid?
 
In AL BCBS has a list of criteria to be met if you are providing anesthesia for endoscopies. It may also depend on anesthesia type or patient age. For instance, BCBS of AL covers them for patients over 50 for screening if they meet the criteria. I would check with BCBS in your state to see if they have any policies or directions for billing endos.
 
Were in California. We have the guidelines and have the surgeons report saying pts are refractive to his moderate sedation and therefore needed our anesthesiologist, but they are still denying them!
 
I googled this question and there is actually a lot out there about this problem. one website was saying that blue cross of ca was wrongfully deneying these claims. has anyone heard of this?
 
other options:

use 995.24 for failed moderate sedation during a procedure or
use V15.80 for a personal history of failed moderation sedation

also, be sure to code the dx's for the reasons for needing anesthesia, such as sleep apnea, morbid obesity, etc.
 
Eff 2/1/10 In Mass - BCBS just put out a policy on 00810 or 00740 if MAC anesthesia not covered unless certain criteria met. So I don't know if your claims are MAC or not but would likely fall into that category. Certain dx's will be covered liked. Check BCBS website for state specific coverage.
 
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