HealthCare News

Anesthesia Claims Processing

Issue: #408 MAY2019

Topic: Coding/Billing


The new Blue Cross Blue Shield of North Dakota (BCBSND) claims processing system requires two specific elements to be reported on anesthesia claims in order to process them in an efficient manner:

  1. A related surgical procedure should be reported on all anesthesia claims.
  2. A claim with a related surgical procedure must be present in the system before the anesthesia claim will be processed.

If the anesthesia claim does not have a related surgical procedure code on the claim this delays the claim processing as the anesthesia claim will then cycle in the system up to three days searching for a claim with a surgical procedure on the same date of service. If a related surgical procedure claim is not found, the anesthesia claim will suspend for manual processing. During manual processing if a surgical procedure claim for the same date of service cannot be found, the anesthesia claim will be rejected. If a surgical procedure for the same date of service is found, the surgical procedure code is entered on the anesthesia claim and the anesthesia claim is then released for processing.

To help outline this process, here are the various scenarios that may occur with anesthesia claims:

  • Anesthesia claim does not have a related surgical procedure code on the claim:
    • Claim will cycle for up to three days
      • If a surgical procedure claim with a matching date of service is not found, it will hold for manual processing
        • If a surgical procedure claim for a matching date of service is not found, the anesthesia claim will be rejected
      • If a surgical procedure claim with a matching date of service is found, the surgery code is manually entered on the anesthesia claim and the anesthesia claim is released for processing
  • Anesthesia claim has a surgery code, but the surgery claim is not found:
    • Claim will cycle for up to three days
      • If a surgical procedure claim with a matching date of service is not found, it will hold for manual processing
        • If a surgical procedure claim for a matching date of service is not found, the anesthesia claim will be rejected
      • If a surgical procedure claim with a matching date of service is found, the anesthesia claim is released for processing
  • Anesthesia claim has a surgery code and a surgery claim is found:
    • The claim will continue processing without manual intervention

To send the Anesthesia Related Procedure Code on an electronic professional claim:

  • In Loop 2300, Segment HI, Element HI01-1, the value “BP” must be present
  • In Loop 2300, Segment HI, Element HI01-2, the Anesthesia Related Procedure Code must be present