Peter Posted Wed 02nd of October, 2019 09:25:53 AM
We started using anesthesia in the office to do our pain procedures. I used code 01936 with modifier QX-which is CRNA service w/medical direction. I have received denial back from medicare of CO-170 ( payment is denied when performed/billed by this type of provider). Could someone please help me with this, thank you in advance for your help.
SuperCoder Answered Thu 03rd of October, 2019 07:01:04 AM
We would like to know who is billing for this service? Physician or CRNA. As per your denial code, it seems CRNA has billed for this service under her NPI. You should bill this service under the physician NPI.
If this does not solve the problem, we request you to share the explanation of benefit (EOB) document provided to you by the payer. This would help us understand the concern related to this code.
Kindly share the EOB on email@example.com.
Peter Posted Thu 03rd of October, 2019 09:06:44 AM
Good Morning, we are billing this service under our physicians NPI number. I am going to forward you the eob. Thank you kindly
SuperCoder Answered Fri 04th of October, 2019 01:42:31 AM
As per EOB forwarded to us, CPT code 01936 has been billed with QZ modifier. QZ modifier is appended with CPT codes for CRNA service without medical direction by a physician. As per query submitted above, QX modifier was appended with CPT code for CRNA with medical direction by a physician. It seems you have appended incorrect modifier by mistake. Append QX modifier with CPT code instead of QZ modifier for service performed under medical direction of physician.
Peter Posted Mon 07th of October, 2019 10:36:38 AM
Thank you for your help, I have emailed you the EOB that I have submitted with denial from that modifier. Thank you
SuperCoder Answered Wed 09th of October, 2019 10:20:45 AM
We are glad to help you.
Kindly bill correct modifier QX instead of QZ with your CPT code. QZ was incorrectly billed as verified from EOB sent to us.
Peter Posted Wed 09th of October, 2019 12:33:15 PM
Hello, I sent another email submitting the other EOB that I have submitted with the modifier and the denial from this. Could you please take a look that email.
SuperCoder Answered Thu 10th of October, 2019 11:48:35 AM
We will call you tomorrow to sort out your concerns.
SuperCoder Answered Tue 15th of October, 2019 10:51:53 AM
Thank you for the call today.
With reference to our interaction, anesthesia code 01936 was billed as an anesthesia service for CPT codes 64493, 64494 and 64495 (Paravertebral facet joint injections). As per American society of Anesthesiologists (ASA), no anesthesia code should be billed with these CPT codes. Morever, facet joint injections were performed in office setting and anesthesia services are generally not paid in office setting. Hence, no anesthesia code should be billed in this case.
Hope. provided information would be helpful.