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Sandeep Posted Mon 08th of January, 2018 07:04:40 AM
We have a group containing GI endoscopic surgeons and anesthesialogist. We are billing CPT for surgery under surgeon and aneshtesia under anesthesiologist seperately with AA and QS modifiers on anesthesia claim. We have received letter from a medicare supplement insurance stating per NCCI edits we are reporting incorrectly. Since we are a single group as per them, we can not report anesthesia claim seperately. The reimbusrsement for the surgeon includes anesthesia charges also. In all these cases Medicare is primary insurance and they have paid both claims seperately , but the supplementary insurance is stating that as per NCCI edits, anesthesia claim is not seperately billable. Is the suppmentary insurance correct? Please provide references for your answer.
SuperCoder Answered Tue 09th of January, 2018 04:13:41 AM


As per NCCI edits guidelines, if codes are not allowed to bill together, then it will not be paid. For example, if CPT 43235 {Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)} and code from anesthesia like CPT 00731 (Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified) billed together, then anesthesia code will be denied as per NCCI not allowed guidelines. Cross check your billed procedure and re-send to the insurance for the payment.

On the other hand, AA modifier is for anesthesia service codes when the provider personally performs the entire anesthesia service, whereas QS modifier is used when the anesthesia provider’s services meet the definition of monitored anesthesia care, or MAC. MAC refers a combination of a local anesthetic with sedation generally administered by a provider who is qualified to provide general anesthesia. And this modifier does not impact reimbursement; it is informational only. Use this modifier in addition to P modifiers for anesthesia codes. Check for the anethesia services you performed.

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