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How to Ask for an Audit
by AJ Riviezzo
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I recently received a couple different inquiries asking about using an anesthesia code. The theory is that the tumescent ‘anesthesia’ that is delivered during an ablation should be reimbursed. Further, each of the practices contacting me know SOMEONE who is being paid for these codes.
You CAN NOT bill an anesthesia code for the tumescent injected during an ablation. It is considered part of the ablation.
If you do bill an anesthesia code for the delivery of tumescent during an ablation, it is possible for you to receive payment. This would be considered FRAUD by an investigator. Recoupment of the monies is the least of the issues once discovered. If the Federal Government is doing the audit, you could be subject to fines and penalties and even, potentially, loss of license.
The CPT manual is very clear on who may and may not bill an anesthesia code. It states:
Anesthesia services may be coded by anesthesiologists or anesthetists working under the supervision of the anesthesiologist. Anesthesia services include pre- and post-op visits, anesthesia delivery, giving fluids and/or blood needed during a procedure, and monitoring. Anesthesia delivery includes general, regional, supplementing local anesthesia and other supportive services.
Unless you are an anesthesiologist providing monitored anesthesia services for a procedure that requires ‘real’ anesthesia, you cannot and should not bill an anesthesia code. The Medicare fraud departments (ZPIC and RAC) can easily run a report comparing use of these anesthesia codes against your Board Certification. Unless you are a Board Certified Anesthesiologist, you have raised a hand asking for an audit.
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Hi there, read your article after searching a lot on internet about it. we are getting denials from aetna and optum for anaesthesia code 01930 for our anaesthesiologist for his services performed during radiofrequency ablation of GSV reported with 36475. i want to know if we can report for tumscent anaesthesia separately for our anaesthesiologist when anaesthesia is given and monitored for procedure code 36475.
Can 96369 be billed for tumescent local anesthetic used during a phlebectomy?