Anesthesia Services: Bundling Denials

Denial Reason, Reason/Remark Code(s)

• B15 - Bundling: Payment adjusted because this procedure/service requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated.
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• CPT code: 99100

Resolution/Resources

• This code is listed as 'Status B' in the Medicare Physician Fee Schedule Database (MPFSDB), which means that payment for this service is always included in payment for other services performed on the same date that are reimbursed under the Medicare Physician Fee Schedule

Multiple Anesthesia Services:

According to the ASA, when multiple surgical procedures are performed during a single anesthesia administration, only the single anesthesia code with the highest Base Unit Value is reported. The time reported is the combined total for all procedures performed on the same patient on the same date of service by the same or different physician or other qualified health care professional. Add-on anesthesia codes (01953, 01968 and 01969) are exceptions to this and are addressed in the Anesthesia Services section and Obstetric Anesthesia Services section of this policy. UnitedHealthcare Community Plan aligns with these ASA coding guidelines. Specific reimbursement percentages are based on the anesthesia modifier(s) reported.

Duplicate Anesthesia Services:

When duplicate (same) anesthesia codes are reported by the same or different physician or other qualified health care professional for the same patient on the same date of service, UnitedHealthcare Community Plan will only reimburse the first submission of that code. Specific reimbursement percentages are based on the anesthesia modifier(s) reported.

In the event an anesthesia administration service is provided during a different operative session on the same day as a previous operative session, UnitedHealthcare Community Plan will reimburse one additional anesthesia administration appended with modifier 59, 76, 77, 78, 79 or XE. As with the initial anesthesia administration, only the single anesthesia code with the highest Base Unit Value should be reported.