Anesthesia providers' colonoscopy payments obstructed by payer problems

by: Julia Kyles, CPC Feb 21, 2018

Poor prep. Gastroenterologists use the term when they can't perform a screening colonoscopy because the patient's lower intestine isn't clean enough. Based on what we're hearing, poor prep describes the efforts of some private payers and Medicare administrative contractors (MACs) to get ready for the new anesthesia codes for gastroendoscopy services (00731, 00732, 00811, 00812 and 00813).

People who will attend tomorrow's webinar on the new anesthesia codes have submitted questions — 17 so far — and warnings about problems they've encountered since the start of the year. Here are a few examples of what people are seeing:

UnitedHealthCare is bundling 00812 into colorectal cancer screening codes G0104, G0105 and G0121 when a certified registered nurse anesthetist who is employed by the gastroenterologist performs anesthesia. Devona Slater, CHA, CMCP, CHC, president of Auditing for Compliance and Education and presenter of tomorrow's webinar, confirmed that one of her clients has encountered this problem as well.
Blue Cross/Blue Shield Federal Employee Program is having problems processing the new codes. "They hope to have all the claims correctly reprocessed in the next 20 to 30 days," the attendee said in an email.
Noridian, the MAC for 13 states and three territories, is rejecting claims for 00811 reported with modifier PT. Slater has heard from clients in Noridian's jurisdiction who have had this problem. In addition, a client in Novitas' jurisdiction reported the same issue.

To sign up for the webinar or obtain the on-demand recording, visit www.codingbooks.com/ympda022218.

Blog Tags: claims processing

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