ASA voiced its concerns that an automated review process could not differentiate when providers inappropriately separately reported typical pre- or post-anesthesia work covered by the base unit value assigned to an anesthesia code and when the codes reported an appropriately reported E&M services for post-op pain follow-up, according to the statement.
After speaking with ASA and consulting with the Centers for Medicare & Medicaid Services, HDI sent ASA the following revisions to its review:
- Automated review will continue to identify improper payments for E&M Services rendered the day of Anesthesia Services (CPT codes 00100 to 01999).
- Findings will include services rendered by the same individual Practitioner as well as services rendered by another member of the same group practice (based on Tax ID#) and of the same provider specialty.
- Automated review for E&M services not rendered on the day of Anesthesia Services (i.e., pre-op and post-op days) were discontinued on March 6, 2010. Consideration of Complex Review audits for pre- and post-operative day anesthesia services will be considered based on additional analysis of the Region D CMS Claims Data and workload priorities.
- Accordingly, the preoperative and postoperative day E&M lines submitted by HDI to Claims Processing Contractors for adjustment under this New Issue are being reversed. Any adjustments made by the CPC for services other than those pre-op and post-op day E&M services should be addressed with the CPC.
Read the ASA’s statement on HDI’s changes to its anesthesia services review (pdf).
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