Wiki Surgeon and Anesth billing different CPT for surgery

[tecmo25]

Hello,

I'm new to billing anesthesia. I have an Medicare HMO insurance carrier that is denying our anesthesiologist claim because the surgeon is billing a different surgery CPT than what we are billing. Per the operative report from the surgeon, the CPT should be 52234; however, the surgeon billed 52204. We did the crosswalk for 52234, not for 52204. Should we change our code to match the surgeons code or have the surgeon change his code? Also, I've been trying to find something on the CMS website that states we have to bill the same code as the surgeon, but cannot find anything. Can someone direct me?

Thanks
Michele CPC

 

[lcole7465]

Hello,

I'm new to billing anesthesia. I have an Medicare HMO insurance carrier that is denying our anesthesiologist claim because the surgeon is billing a different surgery CPT than what we are billing. Per the operative report from the surgeon, the CPT should be 52234; however, the surgeon billed 52204. We did the crosswalk for 52234, not for 52204. Should we change our code to match the surgeons code or have the surgeon change his code? Also, I've been trying to find something on the CMS website that states we have to bill the same code as the surgeon, but cannot find anything. Can someone direct me?

Thanks
Michele CPC

There is nothing stating that the CPT code's have to match, especially when there are multiple procedures performed, then the anesthesia claim would be billed with the ASA/CPT with highest base units.However, since there seems to have been only one procedure performed, then they match as long as they are coded correctly. I would verify query with the surgeon's office on what in the op report had them choose the code they did. If you could attach the pertinent parts of the op report without any patient info, that would help.

 

[LisaAlonso23]

If your anesthesia record states a cystourethroscopy with a bladder tumor removed, 52234 is the correct code to crosswalk. The correct anesthesia code would be 00912. I would definitely request a copy of the operative report to defend your coding.

If your anesthesia record states a cystourethroscopy with a minor lesion removed, 00910 would be the correct anesthesia code.

 

[awilson]

Yes, definitely appeal with the op note.

 

[bbates]

Is there a resource for Anesthesia coding billing for ASC level? Meaning if Anesthesiologist wants us to bill his claim for him? New to anesthesia coding and looking for direction sources. Thank you

 

[thomas7331]

Is there a resource for Anesthesia coding billing for ASC level? Meaning if Anesthesiologist wants us to bill his claim for him? New to anesthesia coding and looking for direction sources. Thank you

I'm not sure I understand your question here. The ASC bills for facility services while the anesthesiologist's services are professional. If the anesthesiologist wants you to bill for him, then you'd likely just need to credential and enroll him as a physician provider under your tax ID and then bill his services as a professional provider on a separate claim. You won't be able to bill a physician's service as part of an ASC claim since these are two different provider types.