amandataylor
New Member
Hello,
Im so confused! I hope some one can help. We coded for anesthesia on a case with 00810 procedure, General Anesthesia, Dx codes 211.3 211.4 V76.51 ( special screening colon cancer).We billed the case out with V76.51 in first position ( maybe we shouldn't have) and were denied for 96 non covered charges ; 04 determination based on LCD ( local) or NCD ( National ) guidelines. When we call Humana Gold Choice we were told by first rep that 00810 was a deleted procedure , by 2,3, and 4th rep due to L24332 and that the dx code 211.3 did not match procedure code and was incompatible. L24332 points to mac anesthesia and those dx codes are not listed but we did not bill mac anesthesia and did not use a mod G8 G9 or QS . The facility billed out the claim with the same dx and were paid as well as the surgeons. We asked what type anesthesia they show ( claim went electronically) they could not tell us nor transfer to another dept, they only want corrected claim. Any Ideas?
Im so confused! I hope some one can help. We coded for anesthesia on a case with 00810 procedure, General Anesthesia, Dx codes 211.3 211.4 V76.51 ( special screening colon cancer).We billed the case out with V76.51 in first position ( maybe we shouldn't have) and were denied for 96 non covered charges ; 04 determination based on LCD ( local) or NCD ( National ) guidelines. When we call Humana Gold Choice we were told by first rep that 00810 was a deleted procedure , by 2,3, and 4th rep due to L24332 and that the dx code 211.3 did not match procedure code and was incompatible. L24332 points to mac anesthesia and those dx codes are not listed but we did not bill mac anesthesia and did not use a mod G8 G9 or QS . The facility billed out the claim with the same dx and were paid as well as the surgeons. We asked what type anesthesia they show ( claim went electronically) they could not tell us nor transfer to another dept, they only want corrected claim. Any Ideas?