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Indiana Medicaid Updates Anesthesia Code Set, Reprocesses Claims Denied in Error

Indiana Medicaid Updates Anesthesia Code Set, Reprocesses Claims Denied in Error

Beginning October 1, 2019, Indiana Medicaid is making a few changes to their Anesthesia code set for traditional fee-for-service Medicaid. In the process, the payer also is reprocessing some claims denied in error as a result of the updates.

AA Modifier No Longer Required on Certain Non-Anesthesia Procedure Codes

First, Medicaid will no longer require anesthesiologists to include the AA modifier on certain non-anesthesia procedure codes, like the placement of central lines or other catheters. This policy change is retroactive back to January 1, 2019.

According to Indiana Health Coverage Plans (IHCP), Table 1, “Procedure Codes That Require the AA Modifier When Billed for Anesthesia Services,” in the Anesthesia Service Codes code set will be removed and considered obsolete.

As well, several non-anesthesia CPT codes approved for use by CRNAs that previously required the AA modifier also have been updated. Codes 36555, 36556, 36620, and 36625 no longer require the AA modifier when billed by a CRNA.

Anesthesia providers should continue to use the AA modifier according to standard coding guidance when billing anesthesia services to Indiana Medicaid, however.

Because the changes regarding the AA modifier are retroactive, some of these codes, which did not have the AA modifier and now no longer require it, may have previously been denied. IHCP has updated their claims processing system and will mass reprocess/adjust affected claims. By October 9, 2019, providers should begin to see these claims reprocessed or adjusted on remittance advices. Look for internal control numbers that begin with 80 (reprocessed denied claims) or 52 (mass replacement non-check related). 

Updates to the CRNA Code Set

Several new codes were added to the CRNA code set effective January 1, 2019; however, some of the codes listed in Table 2 of the Anesthesia Service Codes code set, “Procedure Code Set for Certified Registered Nurse Anesthetists (CRNAs) (Specialty 094),” were not added to IHCP’s claims processing system and were denied as a result. IHCP has updated their claims processing system and will mass reprocess/adjust affected claims. By October 9, 2019, providers should begin to see these claims reprocessed or adjusted on remittance advices. Look for internal control numbers that begin with 80 (reprocessed denied claims) or 52 (mass replacement non-check related). See pages 4-5 of IHCP banner page BR201935 for a list of the affected codes.

Likewise, some codes approved for the CRNA code set were added to the claim processing system but were not listed in Table 2 of the Anesthesia Service Codes code set document. Providers will need to compare their services provided with the list of approved codes and begin submitting or resubmitting claims with these codes on or after October 1, 2019, for DOS on or after January 1, 2019. According to IHCP, “Claims submitted beyond the 180-day timely filing limit must include a copy of this banner page [BR201935].” See pages 5-6 of IHCP banner page BR201935 for a list of the affected codes.

Codes No Longer Covered

Finally, effective October 1, 2019, IHCP will no longer cover the following codes:

  • CPT code 99116 ‒ Anesthesia complicated by lowering total body temperature.
  • CPT code 76937 ‒ Ultrasound guidance for accessing into blood vessel when billed by a CRNA.

For more information about Indiana Medicaid’s updates to the Anesthesia Service Codes code set or the reprocessing of claims related to these changes, check out IHCP banner page BR201935. You also can review the Anesthesia Service Codes code set, though at the time this article was published, the code set had not yet been updated to reflect the changes.

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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