Multiple Anesthesia Sessions in a Day
One issue WPS Medicare has received recently concerns denials of multiple anesthesia sessions on the same day. It appears that providers are not submitting the information WPS Medicare needs to process the claims.
National Coverage Provision (NCP) AN-001 has information on billing for anesthesia services. The anesthesia provider submits one procedure code to reflect the highest base value code for all procedure performed during a single anesthesia session. The time submitted includes the total time for the session.
There are situations where patients have multiple anesthesia sessions in a single day. WPS Medicare will stop the claim for the second session. If the provider tells us in the narrative field that they have documentation available, we will develop. The documentation needs to include the anesthesia record for both services. Medicare can then evaluate and if the record supports, allow both sessions. If the claim does not indicate documentation is available, if we don't receive the documentation, or don't receive documentation for both sessions, we will deny. The provider can then request an appeal.
Providers should have edits within their computer systems to alert them to multiple sessions within a day so they can indicate they have additional documentation available. The staff receiving the development letter should be aware that documentation for both (all) the sessions should be submitted. By complying with these instructions, providers should avoid denials.
