By Shopiha Jain
The year is almost half way through and if you haven't made a note of CPT® code changes for 2013, you could be leaving money on the table.
The year is almost half way through and if you haven't made a note of CPT® code changes for 2013, you could be leaving money on the table.
Keeping track of anesthesia coding guidelines can be a confusing and cumbersome job and leave you scratching your head. The reason that anesthesia billing for dental procedures is so tricky is because the procedure fee often includes anesthesia.
If coding for anesthesia dental procedures is giving you sleepless nights, here are three quick rules that will help you keep your claims clean and let you know when the anesthesia codes just might pay off, so you get the reimbursement that your practice deserves.
Rule #1: Stick to CDT Codes
When coding, do not mix CPT (Current Procedure Terminology) and CDT (Current Dental Terminology) anesthesia codes. Mixing the medical and dental codes will most often cause you to get a denial and also invite scrutiny. This can cause further trouble in case your practice is audited.
Remember that you should use CDT codes only to report the dental claims; and use CPT codes when you are reporting medical claims, unless your payer gives you specific written instructions to do otherwise.
Caution: Do not select your codes until the patient's visit is complete and he leaves your office - the doctor may complete a procedure that includes both anesthesia and evaluation services. Only after you know for sure, what services were performed should you write your claims form.
Rule #2: Make a note of time units
You need to keep an eye on the clock to determine the exact number of anesthesia code units to report. One unit may be equal to 15 minutes.
For example, the dental codes D9221 (Deep sedation/general anesthesia--each additional 15 minutes) and D9242 (Intravenous conscious sedation/analgesia--each additional 15 minutes) describe 15 additional minutes of monitored anesthesia.
When you read the descriptors of the dental codes D9220 and D9241, you will understand that these codes should be reported for the first 30 minutes of the monitored anesthesia services.
To make a note of the time, you must start counting from the moment when the administering doctor begins the anesthesia and non-invasive monitoring protocol. He must remain in continuous attendance during the entire procedure. The counting stops when the doctor safely leaves the patient and the room.
Remember: Some payers may not cover D9242 along with D9241, but you should always report the services the doctor provides and documents. Check with your individual payers' guidelines to know how exactly you should report these services.
Rule #3: Pay Attention to Payer Guidelines
Denials for the anesthesia services are common, but you can head off potential denials by documenting the start and stop times for the anesthesia, the drugs' details (name, amount, etc.), and the medical necessity for sedation.
Remember: The state may require the doctor to have a moderate sedation or general anesthesia permit to perform these services.
If coding for anesthesia dental procedures is giving you sleepless nights, here are three quick rules that will help you keep your claims clean and let you know when the anesthesia codes just might pay off, so you get the reimbursement that your practice deserves.
Rule #1: Stick to CDT Codes
When coding, do not mix CPT (Current Procedure Terminology) and CDT (Current Dental Terminology) anesthesia codes. Mixing the medical and dental codes will most often cause you to get a denial and also invite scrutiny. This can cause further trouble in case your practice is audited.
Remember that you should use CDT codes only to report the dental claims; and use CPT codes when you are reporting medical claims, unless your payer gives you specific written instructions to do otherwise.
Caution: Do not select your codes until the patient's visit is complete and he leaves your office - the doctor may complete a procedure that includes both anesthesia and evaluation services. Only after you know for sure, what services were performed should you write your claims form.
Rule #2: Make a note of time units
You need to keep an eye on the clock to determine the exact number of anesthesia code units to report. One unit may be equal to 15 minutes.
For example, the dental codes D9221 (Deep sedation/general anesthesia--each additional 15 minutes) and D9242 (Intravenous conscious sedation/analgesia--each additional 15 minutes) describe 15 additional minutes of monitored anesthesia.
When you read the descriptors of the dental codes D9220 and D9241, you will understand that these codes should be reported for the first 30 minutes of the monitored anesthesia services.
To make a note of the time, you must start counting from the moment when the administering doctor begins the anesthesia and non-invasive monitoring protocol. He must remain in continuous attendance during the entire procedure. The counting stops when the doctor safely leaves the patient and the room.
Remember: Some payers may not cover D9242 along with D9241, but you should always report the services the doctor provides and documents. Check with your individual payers' guidelines to know how exactly you should report these services.
Rule #3: Pay Attention to Payer Guidelines
Denials for the anesthesia services are common, but you can head off potential denials by documenting the start and stop times for the anesthesia, the drugs' details (name, amount, etc.), and the medical necessity for sedation.
Remember: The state may require the doctor to have a moderate sedation or general anesthesia permit to perform these services.
Stop struggling through the latest anesthesia codes changes alone! Visit SuperCoder to for accurate anesthesia billing for dental procedures. Also get complete information on CPT® code changes for 2013, modifiers, and CCI edits on a single page.
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