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Lori Posted Fri 13th of October, 2017 19:06:31 PM
We have two claims for the same patient, same DOS but two different ASA codes were used by two different providers 00740 & 00790. Are the codes bundled? They are on two separate claims but one is being denied as previously paid for same day. I am a little confused.
SuperCoder Answered Mon 16th of October, 2017 07:43:17 AM

As per the documentation, kindly refer the below mentioned scenarios:

Scenario:1)

If two anesthesia services claims are received for the same patient, same date of service, the first claim processed will be allowed. The second claim processed is subject to denial as services furnished by another provider did not append any medical direction/supervision modifiers. No adjustment for reimbursement to the second anesthesia provider can be made until a corrected claim is received from the first (allowed) anesthesia provider with the missing QK, QX, or QY modifier appended. The billing office for the denied claim is responsible to contact the billing office for the other anesthesia provider involved (supervised CRNA or physician providing medical direction) and arrange for the submission of the needed corrected claim.

 

Scenario:2)

If both the providers are of same speciality, and have a common TAX ID, then only 1 provider can bill for the service performed on the same date. Per the ASA RVG, when multiple surgical procedures are performed, only the anesthesia delivery service code with the highest basic value is reported.

 

Hope this helps!

Lori Posted Thu 22nd of March, 2018 13:20:25 PM
Thank you for your reply. Could you provide where you found this rule for scenario 2? We would like to have the supporting documentation for our records. Much appreciated.
SuperCoder Answered Fri 23rd of March, 2018 01:44:40 AM

Hi,

 

Kindly find the below links for much clarity.

 

Under heading “Harvard Pilgrim Reimburses

https://www.harvardpilgrim.org/pls/portal/docs/PAGE/PROVIDERS/MANUALS/PAYMENT POLICIES/H-1 ANESTHESIA_010118.PDF

 

Under heading “Multiple Anesthesia Services

https://engage.ahima.org/HigherLogic/System/DownloadDocumentFile.ashx?DocumentFileKey=9af2a07d-26e1-4694-b1de-a4c59d0dbc30

 

Hope that helps!

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