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Code 01992

Vicki Posted Thu 10th of November, 2016 11:04:03 AM
We are anesthesiologist performing anesthesia and we are receiving denials from Aetna when we bill a 01992 when procedure for ESI (62311) is being performed by another provider (surgeon). Aetna states denied due to incidental to primary procedure. How would you combat this denial?
SuperCoder Answered Fri 11th of November, 2016 04:59:24 AM

Hi,

CPT code 01992 can only be reimbursed if submitted with modifier AA when performed by anesthesiologist otherwise it will be considered incidental.

Thanks!

Vicki Posted Fri 11th of November, 2016 08:41:13 AM
So a CRNA can not bill for this? Modifier QZ or a anesthesiologist can not medical direct a CRNA using modifier QY?
SuperCoder Answered Mon 14th of November, 2016 06:53:10 AM

Yes, CRNA can bill this service with the appropriate below mentioned modifier:

QX - Anesthesia, CRNA Medically directed
QZ - Anesthesia CRNA not Medically directed.
Also, If you bill QZ, then you will bill QY for the Anesthesiologist (MD)
QY - Medical Directon of on CRNA by an anesthesiologist.

Vicki Posted Mon 14th of November, 2016 12:29:22 PM
We are getting denied by Aetna stating incidental to primary procedure. How can we fight this denial?
SuperCoder Answered Tue 15th of November, 2016 07:30:42 AM

Both services can be bill together when services mentioned above are provided by different physicians(Surgeon and anesthesiologist). Kindly go through below mentioned link:

https://www.supercoder.com/coding-newsletters/my-anesthesia-coding-alert/reader-question-62311-with-01992-depends-on-providers-111315-article

Also, certain payer policies may not allow these codes to be billed together due to there own insurance policy, so you need to ask for the proof of the documented policy where they deny these codes to bill together.

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