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O P H T H A L M O L O G Y
FALSE ALARM
Cataract Anesthesia Denials Cause Stir
N
urse anesthetists sounded the
alarms last month when CRNAs
began receiving denials from
Medicare intermediary Noridian on claims for
anesthesia care delivered during cataract
surgery (CPT 00142) that didn't include documentation of medical necessity.
Several CRNAs we spoke to contacted
Noridian's medical director, Bernice Hecker, MD, MHA, FACC,
who assured them the new medical necessity requirement was a mistake.
"She apologized for the error, and said they would be taking a closer look at
their processes to figure out how it happened, and how to avoid similar errors
in the future,"
says Jay Horowitz, CRNA, owner of Quality Anesthesia Corporation
in Sarasota, Fla.
Dr. Hecker says a scheduled edit update was associated with the problem.
"We took urgent action to terminate the edit when providers alerted us to the
potential of inappropriate denials," she explains. At the time of publication,
Noridian planned on beginning payment adjustments to claims on Jan. 8, and
expected the process to take about 10 days to complete.
The hubbub might have been much ado about nothing, but perhaps not without good reason. Wary anesthetists were aware Noridian stopped reimbursing
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O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | J A N U A R Y 2013
