Double Billing with One Provider

[BloodySurgeon]

Is it an insurance malpractice or a professional malpractice to perform interventional pain procedures while giving nurse directed anesthesia at the same time (versed without another CRNA/AA/MD). The bill to the patient will be for both monitored anesthesia care sedation and for the pain procedure.

What if the patient is willing to pay cash?

I’m asking since I’ve seen this being practice in other locations and wondering if it was taboo because we work with insurance companies who set the rules for billing or is this an actual ASA guideline like you can’t focus on the monitor and move the needle at the same time.

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[chessknt]

I think you can only bill under 99152/3 which has absolute **** reimbursement (from my experience in the order of $30 from private insurance). They came up with this separate code a while ago when GI ripped off cms by 'supervising anesthesia while scoping.

Also using the wrong code to get more money isn't malpractice it is fraud.

 

[BloodySurgeon]

I think you can only bill under 99152/3 which has absolute **** reimbursement (from my experience in the order of $30 from private insurance). They came up with this separate code a while ago when GI ripped off cms by 'supervising anesthesia while scoping.

Also using the wrong code to get more money isn't malpractice it is fraud.

Hmm… sounds right.

 

[chessknt]

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1324CP.pdf

Prior to 2006, Medicare did not recognize separate payment if the same physician provided the medical or surgical procedure and the anesthesia needed for the procedure.
Moderate sedation is a drug induced depression of consciousness during which the patient responds purposefully to verbal commands, either alone or accompanied by light tactile stimulation. Moderate sedation does not include minimal sedation, deep sedation or monitored anesthesia care. In 2006, the CPT added new codes 99143 to 99150 for moderate or conscious sedation. The moderate (conscious) sedation codes are carrier priced under the Medicare physician fee schedule.
CPT codes 99143 to 99145 describe moderate sedation provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status. The physician can bill the conscious sedation codes 99143 to 99145 as long as the procedure with it is billed is not listed in Appendix G of CPT. CPT codes 99148 to 99150 describe moderate sedation provided by a physician other than the health care professional performing the diagnostic or therapeutic service that the sedation supports.

CPT Coding Changes For Moderate Sedation in 2017 - American College of Cardiology

www.acc.org

Updated more recently. I think it is like 0.1 wrvu which is as much as I get for reading a pft which takes 2 minutes max. It is a big reason why proceduralists just ask for anesthesia to come by because the juice ain't worth the squeeze and someone else gets to chart and deal with pacu crap.

 

[GassYous]

CPT Coding Changes For Moderate Sedation in 2017 - American College of Cardiology

www.acc.org

Updated more recently. I think it is like 0.1 wrvu which is as much as I get for reading a pft which takes 2 minutes max. It is a big reason why proceduralists just ask for anesthesia to come by because the juice ain't worth the squeeze and someone else gets to chart and deal with pacu crap.

What about the pain surgery and gi people that hire crnas and take their billings

 

[abolt18]

If the patient pays cash, don't know why the billing matters at all.

 

[nimbus]

Oral surgeons do this all the time. Various anesthesia societies have put out sternly worded statements against it but it is legal as far as I know.

 

[IMGASMD]

Oral surgeons do this all the time. Various anesthesia societies have put out sternly worded statements against it but it is legal as far as I know.

But they do one month of anesthesia rotation. Also give each other high fives while doing each other’s sedation. They got this.

 

[chessknt]

What about the pain surgery and gi people that hire crnas and take their billings

Then it is different because there is a dedicated anesthesia provider there and thus a different CPT code.

If the patient pays cash, don't know why the billing matters at all.

Are they paying cash for the procedure though or just the anesthesia portion? If just the anesthesia portion I would make sure it doesn't violate any cms rules about balance billing.

 

[abolt18]

But they do one month of anesthesia rotation. Also give each other high fives while doing each other’s sedation. They got this.

5-6 months of anesthesia here for them.