Reader Questions: Get the Scoop on Billing Before Credentialing   (August 2010)

Question: Our practice has a new physician coming on board to replace a retiring doctor. When can I start billing for his services? Does it matter when he gets credentialed with the insurance companies?
Ohio Subscriber
Answer: When you can bill for a new physician’s services does depend on when you’re able to get him credentialed. You’ll also need to know the differences between the payers you’ll be reporting the services to.
Medicare: For Medicare, you’re allowed to [...]

Reader Questions: Coding for Standby CRNA Service   (August 2010)

Question: An obstetrician called one of our CRNAs for standby service during a twin delivery due to the chance of a cesarean section. The physician delivered the babies vaginally, however, so the CRNA completed only standby service. Can we bill an E/M code or another service for her time?
Michigan Subscriber
Answer: You describe a difficult coding situation because 99360(Physician standby service, requiring prolonged physician attendance, each 30 minutes [e.g., operative standby, standby for frozen section, for [...]

Code Changes: Category III codes introduce welcome transforaminal changes   (July 2010)

Bonus: Prepare for neonate hypothermia options in Jan. 2011.
July brings announcements regarding new Category III codes, so prepare now for new transforaminal epidural and hypothermia codes just going into effect or that you’ll use beginning Jan. 1, 2011.
Start Using New Transforaminal Choices
The American Medical Association (AMA) released four new transforaminal injection codes in January. They went into effect July 1, so update your systems accordingly:
0228T – Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, [...]

CCI 16.2: New Edits Bundle Paravertebral Facets With All Anesthesia, Some Nerve Procedures   (July 2010)

Checkpoint: Don’t assume separate coding for J0670 anymore, either.
The latest Correct Coding Initiative (CCI) edits contain plenty of anesthesia and pain management pairs you should check – and straight away. They went into effect July 1. CCI 16.2 encompasses 16,843 new edit pairs, according to analyst Frank Cohen, MPA, of MIT Solutions, Inc., in Clearwater, Fla. With 11 percent of all active edits affecting anesthesia procedures, you can’t afford to miss any of the changes.
Other Work [...]

Reader Questions: Work, Not Location, Defines Anesthesia End Time   (July 2010)

Question: I’ve seen several descriptions of anesthesia end time, but still am not clear on some details. Should the anesthesia end time be just before the notation that post-anesthesia care begins?
Michigan Subscriber
Answer: Just because a patient moves to a post-anesthesia care unit (PACU) doesn’t mean your provider’s responsibility ends. The anesthesiologist or CRNA might continue monitoring the patient in the PACU for several minutes, so changing locations doesn’t constitute an automatic hand-off in care. [...]

QC Codes: Boost Your Bottom Line With Qualifying Circumstances Codes   (July 2010)

Tip: Medicare doesn’t reimburse, but other payers still might.
Traditional Medicare plans never cover qualifying circumstances (QC) codes +99100-+99140, but that doesn’t mean you should steer clear of reporting them to other payers. Read on for three areas to watch before adding any QC codes to your claims:
+99100 – Anesthesia for patient of extreme age, younger than 1 year and older than 70 (List separately in addition to code for primary anesthesia procedure)
+99116 – Anesthesia complicated by utilization [...]

Reader Questions: Follow Payer Preference for Multi 64640   (July 2010)

Question: How do we correctly bill multiple radiofrequency ablations of the lumbosacral lateral branches? Do we append modifier 51 to any ablation after the first?
Virginia Subscriber
Answer: Begin with procedure code 64640 (Destruction by neurolytic agent; other peripheral nerve or branch), then check with your payer about how to report additional ablations.
Option 1: Submit 64640 on the same line for each ablation (64640 x 4 for four ablations, for example). Append either LT (Left side) or [...]

Reader Questions: Look to 64400 for Mandibular Nerve Block   (July 2010)

Question: Our physician administered a nerve block to the mandibular nerve. Which nerve injection code should I report?
Massachusetts Subscriber
Answer: Because the mandibular nerve is the largest of the three branches of the trigeminal nerve, your best choice is 64400 (Injection, anesthetic agent; trigeminal nerve, any division or branch). Code 64400 more accurately describes the injection site than other options you might have considered, such as 64402 (… facial nerve) or 64450 (… other peripheral [...]

Reader Questions: Contract Doesn’t Negate Standby Service   (July 2010)

Question: The obstetrician requested that our anesthesiologist be on standby during the delivery of twins because she was concerned that a cesarean section might be necessary. The anesthesiologist was present for the delivery but did not provide any services. Our anesthesia group is contracted to provide 24-hour in-house coverage at the hospital. Does that affect how (or if) we can bill for physician standby?
Illinois Subscriber
Answer: Assuming the anesthesiologist was on standby for this patient [...]

Reader Questions: No Pre-Exam? Still File Claim   (July 2010)

Question: A patient was admitted through the Emergency Department and went immediately to surgery. The case was so critical that there was no time for a pre-anesthesia examination. How do we document and bill for the anesthesia?
Wyoming Subscriber
Answer: The anesthesiologist should bill his services in the same manner as any other anesthesia service. The base value of anesthesia codes includes all usual pre- and postoperative visits. When the anesthesia provider is unable to perform [...]