269Denial Code (CARC)Active
CARC 269 Denial Code - Anesthesia Not Covered
Code 269 indicates that anesthesia charges are not covered for the specific service or procedure on the claim. This means the payer has determined that anesthesia should not have been billed separately or is not reimbursable for this type of service.
Who Pays: Group Code Liability
If the group code is CO, the provider must write off the anesthesia charge as a contractual obligation, and the patient cannot be billed. If the group code is PR, the patient may be billed for the anesthesia service.
Why Claims Get Code 269
- The procedure performed does not typically require anesthesia.
- The payer's policy excludes anesthesia for this specific service.
- An incorrect anesthesia billing code was used.
- The claim lacks necessary documentation supporting the need for anesthesia.
- The anesthesia service was billed separately when it should have been included in the procedure code.
How to Fix & Resubmit
- Verify the payer's coverage policy for anesthesia related to the billed service or procedure.
- Check the procedure's billing guidelines to ensure anesthesia can be billed separately.
- Review the claim for any documentation errors or missing information supporting anesthesia use.
- If anesthesia should be covered, correct the claim with the appropriate codes or documentation.
- Resubmit the claim or file an appeal if the denial was made in error.
Corrected Claim or Appeal?
Submit a corrected claim if the anesthesia service was billed incorrectly. If documentation supports anesthesia coverage, appeal the denial with the necessary records. Neither is needed if the denial aligns with your contract terms.
Preventing Future 269 Denials
- Review payer contracts for anesthesia coverage specifics before billing.
- Ensure proper coding guidelines are followed for procedures involving anesthesia.
- Include all necessary documentation to support the need for anesthesia in initial claim submissions.
- Train billing staff on anesthesia billing nuances to avoid incorrect submissions.