Does ABI have your current email address?
Anesthesia Billing, Inc. (ABI) has historically sent general communication through the USPS and has recently begun to add email blasts as an option. Like everyone we would like to save our natural resources by reducing the amount of paper we use to communicate with our friends and clients. In addition to sending general correspondence, we would like to also send newsletters and memo items, articles of interest, payer updates, etc. There will be no changes in the way you currently receive your monthly statements and reports. Those items will continue to be sent as you have requested. However, if you are receiving your monthly reports in paper format and would like to begin to receive them electronically, please give us a shout to get this changed over for you. In the future, we hope to have a web portal for all our clients to securely retrieve reports, access invoices, and communicate more efficiently with our office. Stay tuned.
To ensure we have the most up-to-date email address on file for you, please submit a quick email, with a Subject line of: Current Email, from the address you would like to receive any email correspondence, to Stephanie Kurtz, skurtz@anesthesiabilling.com. If there are additional email addresses you would like included, please feel free to list those addresses in the body of the email you send. Thank you for your help with this project!
Payer Pre-Authorization List
Payers, insurance companies, each have a list of procedures, which must be pre-authorized prior to performing the service to their member. Anesthesia providers are not required to get the services pre-authorized as long as the surgeon/facility has done so. Please be aware, those procedures that require but are not pre-authorized will not get paid.
Are you HIPAA Compliant?
A recent Facebook gaffe in Rhode Island involved an emergency room physician who posted information on her personal Facebook page about a patient she treated in the ER. Although she did not name the patient, she shared sufficient details about the accident and injuries that unauthorized third parties were able to identify the patient. The consequences cost her, her job and placed a reprimand in her permanent file with the Board of Medical Licensure. Social media exposes everyone in the healthcare industry to great risks. Many providers use chat rooms to discuss cases, treatments, and other medical information. The key is to not post any information that can identify the patient. This applies to simple email communications with co-workers and your billing office. Four simple tips to follow: 1. Make sure to understand the medium you are using to communicate. 2. Do not post patient or other information that can identify a patient. 3. Develop a policy on protecting Patient Health Information (PHI) and ensure everyone follows it. And 4. Assume everything will become public. Anesthesia Billing, Inc. has a secure means to securely send PHI. Fax and US mail are both considered secure ways to send PHI. If you are not already set up to use our secured site and need to do so, please get with Thad Willis, twillis@anesthesiabilling.com or by phone (316) 281-3719, and he will be glad to get your username and password established for you. This physician was lucky. There are very stiff penalties for sending any PHI unsecured.
Diagnosis (ICD-9) Codes which do not support Medical Necessity
CMS and local Medicare/Medicaid Carriers have specific diagnosis codes that support medical necessity for particular procedures. If a diagnosis is used and is not in their list, the procedure will be denied as being not medically necessary. (For example: CPT codes 64493, 64494, 64495, 64622, 64623, 64626, and 64627 are not considered medically necessary when billed with diagnosis 724.8.) The provider is responsible for obtaining a signed ABN the day of and prior to the procedure from the patient stating the patient is aware they may be responsible for the charges for diagnosis not medically necessary. (A sample ABN has been included.) If an ABN is not obtained and the procedure is denied, you will not be paid for your services. Please be aware of what diagnosis codes are not covered and obtain the ABN signed by the patient. Please submit those signed ABN’s to our office with your charge tickets. It is necessary to bill the procedure with a –GA modifier in order to later bill the patient in case of denial. If you are unsure of what diagnosis codes are not covered, and cannot locate those on the CMS or local Carrier websites, please feel free to contact our office.
BCBS of Kansas has issued a Policy Change
Injection into the sacroiliac joint has historically been considered experimental/investigational without any exceptions; however, BCBS of KS has now made an exception for the following conditions. All conditions must be met for the test to be considered medically necessary:
- Pain originates from the sacroiliac joint; and
- Duration of pain of at least 3 months; and
- Average pain level of ≥ 6 on a scale of 1 to 10; and
- Failure to respond to more conservative management including physical therapy and non-steroidal anti-inflammatory agents; and
- Lack of obvious evidence for disc related or facet joint pain
Repeat injections are to be no more frequent than every 2 months. Repeat injections extending beyond 12 months may be reviewed for continued medical necessity.
Sacroiliac injections are considered experimental/investigations for all other indications.
Arthrography of sacroiliac joint is considered experimental/investigational.
If someone shows up in an ER or is scheduled through a treatment room or surgery and the above conditions are not met – the patient must sign the BCBS patient waiver or ABN in order for the charges to become the patient’s responsibility.
If you would like to review the entire Medical Policy, please access online at: http://www.bcbsks.com/CustomerService/Providers/MedicalPolicies/policies/policies/SacroiliacJointArthrography_Injection_2011-06-27.pdf
United Healthcare (UHC) Policy Changes
UHC recently released their third and fourth quarter policy changes. Within those bulletins, there were a couple of items we would like to share.
UHC Anesthesia Policy Revisions, Effective Third Quarter 2011
“United Healthcare will adopt additional Centers for Medicare & Medicaid Services (CMS) National Correct Coding Initiative (NCCI) edits for moderate sedation services (99143-99150) and CPT Appendix G codes reported with anesthesia management service (0100-0199 excluding 01996) rendered by the same individual physician or health care professional. The CMS NCCI bundling edits will be managed in the CCI Editing Reimbursement Policy. The CPT Appendix G codes will be managed in the Anesthesia Policy. Refer to the below list for complete list of CPT Appendix G codes to be managed in the Anesthesia Policy. You may also access the list of codes at: http://www.uhc-networkbulletin.com/page.aspx?QS=472529ec60bdf32ad777244eedc40197d03ce340dc6e52e05373b8872b7c50b0
Edits that will deny E/M codes when reported with a non-E/M service, unless the E/M is reported with modifier 25
| PROC_CODE (trigger = pay) |
PROC_BEG (target = deny) |
| 19298 | 00400 |
| 20982 | 01220 |
| 22526 | 01936 |
| 32201 | 00540 |
| 32550 | 00520 |
| 32551 | 00520 |
| 32553 | 00520 |
| 33010 | 00520 |
| 33011 | 00520 |
| 33212 | 00400 |
| 33213 | 00400 |
| 33222 | 00400 |
| 33223 | 00400 |
| 33233 | 00400 |
| 33234 | 00520 |
| 33235 | 00520 |
| 33240 | 00400 |
| 33241 | 00400 |
| 33249 | 00537 |
| 36481 | 01931 |
| 36557 | 00532 |
| 36558 | 00532 |
| 36560 | 00532 |
| 36561 | 00532 |
| 36563 | 00532 |
| 36565 | 00532 |
| 36566 | 00532 |
| 36568 | 00532 |
| 36570 | 00532 |
| 36571 | 00532 |
| 36576 | 00400 |
| 36578 | 00532 |
| 36581 | 00532 |
| 36582 | 00532 |
| 36583 | 00532 |
| 36585 | 00532 |
| 36590 | 00400 |
| 37183 | 01931 |
| 37216 | 01925 |
| 43216 | 00740 |
| 43453 | 00520 |
| 43456 | 00520 |
| 43458 | 00520 |
| 44500 | 00740 |
| 44901 | 00800 |
| 45303 | 00902 |
| 45305 | 00902 |
| 45307 | 00902 |
| 45308 | 00902 |
| 45309 | 00902 |
| 45315 | 00902 |
| 45317 | 00902 |
| 45320 | 00902 |
| 45321 | 00902 |
| 45327 | 00902 |
| 47011 | 00790 |
| 47382 | 00790 |
| 47525 | 00700 |
| 48511 | 00790 |
| 49021 | 00800 |
| 49041 | 00790 |
| 49061 | 00820 |
| 49411 | 00790 |
| 49418 | 00840 |
| 49440 | 00700 |
| 49441 | 00700 |
| 49442 | 00700 |
| 49446 | 00700 |
| 50021 | 00860 |
| 50200 | 00860 |
| 50382 | 00860 |
| 50384 | 00860 |
| 50385 | 00910 |
| 50386 | 00910 |
| 50387 | 00862 |
| 50592 | 00862 |
| 50593 | 00862 |
| 58823 | 00860 |
| 66720 | 00140 |
| 69300 | 00120 |
| 77371 | 01922 |
| 92960 | 00410 |
| 92961 | 01926 |
| 92975 | 01920 |
| 93561 | 01920 |
| 93562 | 01920 |
UHC Documentation Requirements for Ablative Treatment for Spinal Pain
The coverage criteria for thermal radiofrequency ablation of facet joint nerves has been updated to include additional conditions that must be met/confirmed and the documentation submission requirements have been expanded. If you perform thermal radiofrequency ablations as of June 1, 2011, you will be required to submit specific clinical information to United Healthcare in order to fulfill the clinical coverage review requirement. The submitted medical records must now clearly document the following:
- Temperature of administration of procedure
- Duration of ablation
- Specific identification of side and level of medical branch blocks
- Specific cervical, thoracic and/or lumbar ablated by side and level
- Percentage of pain relief with prior ablation, if applicable
- Duration of improvement from previous ablation, if applicable
UHC Anesthesia Policy Revision, Effective Fourth Quarter 2011
The Anesthesia Policy currently states that when multiple surgical procedures are performed during a single anesthesia administration, only the anesthesia management service code (CPT® codes 00100-01999 excluding 01996) with the highest basic value should be reported. When subsequent anesthesia management services are necessary for a patient returning to the operating room on the same day, UnitedHealthcare has historically advised providers to report CPT® modifiers 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional) or 77 (Repeat Procedure by Another Physician or Other Qualified Health Care Professional) on the subsequent operative session to obtain separate reimbursement.
The policy will be revised to also allow separate reimbursement of subsequent anesthesia procedures in different operative sessions when reported with CPT® modifiers 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician), 79 (Unrelated Procedure or Service by the Same Physician), or 59 (Distinct Procedural Service).
CMS Eliminates Consultation Codes
In the January 2010 ABInsight, ABI notified our providers of a change in CMS claim processing. This publication was to notify you that CMS (which includes Medicare, Medicaid and any Replacement Plans) was to halt payment for the in-office consultation codes (99241-99245) and inpatient consultation codes (99251-99255). Instead of reporting consult codes, it is necessary to report an initial hospital, initial nursing home visit, or a new or established patient office visit (E/M) code for these services. This publication was rather lengthy and gave a lot of important information. It is suggested to review the information included in this publication.
We are seeing some of our providers submit the consultation codes (99241-99245 and 99251-99255) for Medicare, Medicaid and/or Replacement Plans (Unicare, Children’s Mercy, Medicare Advantage, etc). Please be reminded these charges will be denied and will not be payable. If you would like a copy of the January 2010 ABInsight or have questions regarding these changes, please call our office and request to speak to Kelley Tessendorf or Alisa Dinneen at (316) 281-3700.
abinsights Contact Information
abinsights readers are invited to submit comments, questions, tips, and suggestions for articles on any subject related to billing, collections, coding, reimbursement, and compliance. Send to: Anesthesia Billing, Inc., P O Box 388, Newton, KS 67114-0388. Phone 316-281-3700. Fax 316-282-4322.
Our purpose is to help you meet inevitable challenges. We hope to deliver practical knowledge and solutions drawn from top resources and business publications in every issue, knowledge you can use today.
Reasonable attempts have been made to be accurate. However, medical billing, collections, coding and compliance are part science, part art, and even experts sometimes differ. Neither Anesthesia Billing, Inc., the editors, publisher, contributors, or consultants warrant or guarantee the information contained will be applicable or appropriate in all situations. For information specific to your practice, consult a qualified professional.
The information included in this publication is provided, among other things, to alert you to legal developments and should not be considered legal advice. Specific questions about how this information affects your particular situation should be addressed to your attorney.
Editor: Philip Blann (pblann@anesthesiabilling.com).
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