Wiki Procedure codes 01935 and 01936

[Michellecepedaqbs@gmail.com]

Good afternoon,

My anesthesia group is billing these 2 codes but we are having a hard time collecting from Blue Shield. Their denial reason is there is no authorization for the procedure. I have argued as Anesthesiologist we do not otain authorization however they are still not paying. Im rather new to the coding world so I wanted to know if anyone else was experiencing this issue. I'm located in New Jersey.

Thank You

 

[dwaldman]

We are out of network with BCBS so we don't see hardly any of these patients. But I think the private payers know that 01935 and 01936 are associated with certain pain management procedures and these are typically performed under MAC with these codes and they might not like having to reimburse in addition to the pain procedure for separate providers. But I don't know their specific reasoning that you are addressing.

 

[diane1217]

I think you'll need to go to the Blue Shield website and review their medical policy for the procedure that the MAC anesthesia is for, because if the injection is not covered by BS, then they certainly will not pay for anesthesia for a procedure they do not cover.