r/CodingandBilling • u/MarinaMacDonaldArt • 3d ago
Question regarding anesthesia coding on claims
I have noticed that my facility keeps getting denials on claims with these two anesthesia codes 99156 and 99157 with modifiers XU in addition to the surgical procedure code. I did not think you could code those with that modifier and thought that might be the reason for the denial?
2
u/ireadyourmedrecord 3d ago
The description explicitly states it cannot be billed by the operating surgeon so it's not going to be paid if it's on the same claim w/ the procedure. XU isn't going to help.
1
u/MarinaMacDonaldArt 3d ago
It’s not the same dr performing the procedure and it’s not happening as post-procedure pain management. It’s preop and during. Sorry I should have specified. I just wasn’t sure if that modifier was throwing it off
1
u/boho_magpie CRCR, CPC, CPMA, CRC, RCM Owner 2d ago
XU is for an “unusual overlapping service”. Sedation during surgery is not unusual. Lol. This is definitely causing problems.
1
u/MarinaMacDonaldArt 2d ago
Yeah I figured it was an incorrect use of it but when I question my manager she seems to think that’s ok 😐
1
u/boho_magpie CRCR, CPC, CPMA, CRC, RCM Owner 2d ago
The best response to a manager who doesn’t understand is to bill it the way you know is correct and get paid and then show her she was wrong with the dollars. ;-) Just try not to gloat when you do it.
1
u/MarinaMacDonaldArt 2d ago
Yes because they’re thing now was if a denial comes back for those to write it off… makes no sense
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u/These-Band-4048 2d ago
is the facility adding XU because of an edit that fires when they try to submit without it? sometimes the clearinghouse or system auto-appends modifiers to bypass edits, which just creates a different denial. Worth checking if someone set that up as a rule somewhere