Anesthesiologists who cover patients during certain gynecologic procedures need to closely monitor claims denials from Anthem Hoosier Healthwise (HHW).
CIPROMS recently encountered several denials for anesthesia services during intraperitoneal or vaginal procedures because no signed sterilization consent form was provided. While Medicaid policy (Chapter 8, page 475) does require providers to include the consent form for sterilization services, in these instances, the procedure did not include sterilization and still was denied.
According to an Anthem HHW representative, an edit in the payer’s claims system is incorrectly flagging all procedures 00840 and 00952 for the consent forms rather than flagging them based on diagnosis. The Medicaid provider manual (Chapter 8, page 476) indicates that some anesthesia procedures used only for sterilization procedures should always be flagged for consent such as 00851 for tubal ligations and 00921 for vasectomies. Other procedures used more generally, like 00840 for intraperitoneal procedures and 00952 for vaginal procedures, should be flagged only when accompanied by a diagnosis indicating the sterilization.
Medicaid policy also requires consent for hysterectomies, and payer systems processing Medicaid claims should flag certain anesthesia procedures used for those services only: 00846 for radical hysterectomy, 00944 for vaginal hysterectomy, and 01962, 01963, and 01969 for hysterectomy after various types of labor and delivery procedures. Other general procedures also used for hysterectomy like 00840 or 00952 indicated above, however, should be flagged only when accompanied by a diagnosis indicating the hysterectomy.
According to an Anthem Hoosier Healthwise representative, claims incorrectly denied by Anthem Hoosier Healthwise should be automatically reprocessed for payment after the edits have been revised. You or your billing company may want to contact Anthem Hoosier Healthwise preemptively to request a sweep of all claims denied in error.
For more information, contact Anthem Hoosier Healthwise or call Andrea Halpern at CIPROMS at 317.870.0480.
— All rights reserved. For use or reprint in your blog, website, or publication, please contact us at firstname.lastname@example.org.