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MAY 2011 Newsletter:
It's hard to believe that we are almost half way through 2011. With the planning and initiates tied to the 1st quarter of the year behind us and hopefully underway I believe that it's a great time to stop and reflect on what's been accomplished this year so far and what still needs to be done for the second half of the year.
For physician practices, hospitals, and billing companies it is easy to get caught up in tasks that are primarily focussed on the reimbursement side of the business as many find that their payments have been cut in the past 12 - 18 months. One area that we mustn't lose sight of in the meantime is... you guessed it: COMPLIANCE. No matter how the healthcare industry changes there is one thing we know for certain: the need for compliance will not be going anywhere. ACE Auditor, Donna Schlemmer, has contributed the following article on this topic: "Will Your Compliance Program Survive the Patient Protection and Affordable Care Act?" Take a moment to read Ms. Schlemmer's article and contact ACE if you need assistance with keeping your compliance program active.
Another featured article pertains to the bundling rules and how coders should use the NCCI edits to ensure that they are coding correctly. ACE Auditor, Judi Blaszczyk, gives you some insight in her article titled: "Befuddled by the Bundling Rules?"
Please don't hesitate to every call the ACE office with questions on anesthesia and pain billing, coding and compliance. Or you can submit a request for information through our website.
In this issue:
Ask ACE
In this continuing series, ACE Auditors answer some of the common questions we receive related to anesthesia and pain mangement billing, coding, and practive management
Question: What are other groups doing regarding the ASA Statement in the Relative Value Guide, that MAC anesthesia is not medically necessary for routine pain blocks? In the anesthesia Crosswalk there is not an ASA code for the 62311/62310.
Answer: Individual carrier LCD have also published that MAC is rarely needed for routine pain blocks. Education should be provided on the changes regarding the ASA Relative Value Guide for all providers.
The crosswalk also gives guidance that it is important to note that conditions may exist, which would make skilled anesthesia care necessary for procedures not normally requiring such care.
A statement of medical necessity should be clearly documented in the patient medical record for those cases that could potentially warrant the services.
The selection of the ASA code is based on the site or circumstances of the surgical procedure. It is important to note the listing of a CPT-4 codes does not limit or restrict the use an ASA code. In those particular cases where the documentation would support 'medical necessity' the selection of the ASA code should be determined based on that instruction from the crosswalk.
The 2011 ASA codes still represent reporting:
Anesthesia for diagnostic or therapeutic nerve blocks and injections (when block or injection is performed by a different provider);
ASA 01991 Other than prone position (3 units)
ASA 01992 Prone position (5 units)
Anesthesia for percutaneous image guided procedures on the spine and spinal cord;
ASA 01935 Diagnostic (5 units)
ASA 10936 Therapeutic (5 units)
Question submitted by ACE Consultant, Susan West, RHIT Click here to read Susan's bio.
To submit a question to one of our consultants click here.