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01936 bundled with 72275

K Posted Tue 09th of June, 2015 11:22:21 AM

We have claims that will deny 01936 as bundled with 722.75. We have a CRNA that is providing the service 01936. They are not being medically directed. The provider is performing the epidurography with other procedures and they will deny and not pay the CRNA claim. Why would the 72275 be bundled with an anesthesia code? Any Ideas on what we can do with our billing to receive reimbursement?

SuperCoder Answered Wed 10th of June, 2015 03:46:28 AM

CCI bundles code 01936 as column 2 code under 72275 as column 1 code, with modifier indicator "0". This means you cannot break the bundling in any circumstance.

Who is performing the epidurography? The surgeon or the CRNA? If it's being performed by the surgeon, you create 2 claims - one for 72275 for the surgeon and one with 01936 with mod. QZ for the CRNA and report respective claims under individual's NPI.

If the CRNA is performing both procedures, you certainly cannot bill 01936 with 72275.

K Posted Wed 10th of June, 2015 11:36:09 AM

The surgeon is performing the epidurography and the CRNA the anesthesia. We are billing with two claims with the individuals NPI number. It is still being denied due to CCI edits...any additional ideas to help anesthesia get paid?

SuperCoder Answered Thu 11th of June, 2015 03:55:45 AM

Then there should be no issue. Appeal the claim rejection with 2 fresh claims and submit the documentations along with. Submit an appeal letter and explain which doctor did which part. Mention clearly that 2 different physicians - one surgeon and one anesthesiologist with their individual & separate NPI no. are performing 2 separate procedures (one of which is anesthesia).

Bill one claim with 72275 for the surgeon and one with 01936 with mod. QZ for the CRNA. Submitting the documentations (highlight the parts for each doctor's work) with explanatory letter should settle this.

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