Wiki Noridian Medicare Medical Necesity Denials

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missyah20

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Good Afternoon,
I have a couple of practices in Oregon where we have started to see Medicare Part B denials for anesthesia code 00142 (but also 00140, 01810, 01480) when billed with a QS modifier as "not medically necessary".

I called their provider customer service and the first rep told me that she couldn't find an LCD that included code 00142. I agreed with her as LCD L24332 for Monitored Anesthesia Care doesn't include that anesthesia code. She said she would research.

I received a general message to call Noridian back which I did today and now another rep is telling me that they are denying this because it is billed with a QS and the Anesthesia Code 00142 isn't listed in the policy.

This doesn't make any sense to me and I am kind of at a loss as to how to continue pursuing these denials.

Has anyone else out there received denials such as this for Noridian Medicare?
 
After hearing back from the Director of Noridian they are telling us that it was a system error that occured with the update on 12/10 and hopefully Noridian will have a release on this in the upcoming days.
 
Medcr Denials

For Medicare patients

if MAC is used for eye surgery's(ie 00140 and 00142) we code with AAQS -- when provider is MD

or

QZQS if provider is CRNA -


never QS alone -- always get paid
 
They claims were billed with the appropriate anesthesia modifier (AA, QZ, etc) and then the QS and were still denied due this system update from Noridian.
 
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