There has been much confusion surrounding the HIPAA 5010 requirements for anesthesia services. The American Society of Anesthesiologists (ASA) has released guidance on the matter.
Here is a brief rundown of the ASA’s responses:
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Surgical code is not required for anesthesia claims. “The new standards allow anesthesiologists to submit surgical codes if they want to do so, but does not require this,” the ASA writes on its website. “The ASA is working with X12 and payers to clarify these new requirements and the limits to which payers can require additional information on claim forms.” Important: Some payers have interpreted this new ability as a requirement and have edits for surgical codes on anesthesia claims. If the surgical code is missing, the test claims to be rejected. Check with your payers to see if this edit is in place to make sure your claims won’t be rejected. NOTE:The surgical code is only reported on an anesthesia claim when the anesthesiologist knows the surgical code and it is necessary for claim adjudication, according to the HIPAA standards. TIP: Payers can require surgical codes be on claims in your contract, the ASA says. Review each of your contracts for any requirements that differ from the HIPAA 5010 standards.
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Documentation for claims with “not elsewhere classified (NEC)” or “not otherwise specified (NOS)” descriptors. The ASA is working with payers to clarify how NOS is used differently in the anesthesia codes than for surgical codes.
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Reporting in minutes instead of units. “Payers can still pay based on time units by converting the number of anesthesia minutes to time unitsthrough contractual arrangements between payers and anesthesiologists.
You can find the ASA’s complete response on their website at http://www.asahq.org/.