# CRNA does not stay for the entire case - can I still bill for them?



## iceterrors (Feb 27, 2018)

Good Morning, Everyone

Here is the scenario: MD1 and the CRNA began the case. CRNA left after 46 minutes. MD 2 appears to have given MD 1 a break midway through the case - my question is do I ONLY bill for MD1 with the AA modifier, or do I bill for MD1 (QY) AND the CRNA (QX) ?

Name: MD 1   
     Start Time: 02/26/18 14:10:00    Stop Time: 02/26/18 15:59:00    Total Time: 109
Name: MD 2 Activity: Supervisor    Concurrency/Res: 1/0
     Start Time: 02/26/18 16:00:00    Stop Time: 02/26/18 16:18:00    Total Time: 18
Name: CRNA     
     Start Time: 02/26/18 14:10:00    Stop Time: 02/26/18 14:56:00    Total Time: 46
Any and all help is greatly appreciated!!
M


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## awilson (Mar 11, 2018)

I think I’m this situation, you would bill both-unless the md is directing other cases at the same time.. that’s when things get tricky. But if it’s a single directed case.. I don’t see the md taking over as a problem. You would only enter the time that the crna was actually on the case and the full time for the md- if he had directed the first part as well. Hope that makes sense.


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## iceterrors (Mar 22, 2018)

Thank you - I'm going to see how that plays out.


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## Athorndike (Oct 9, 2018)

*Are the rules for the changing of concurrency in the middle of a case?*

I have a Anesthesiologist working alone than a CRNA joins them in the middle of a case. My billing system will not let us change from a AA to QY in the middle of
a case. How should we bill this case?


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## aparnita bakshi (Oct 12, 2018)

As per the definition of Anesthesia time it states- Anesthesia time is defined as the period during which an anesthesia practitioner is present with the patient. It starts when the anesthesia practitioner begins to prepare the patient for anesthesia services in the operating room or an equivalent area and ends when the anesthesia practitioner is no longer furnishing anesthesia services to the patient, that is, when the patient may be placed safely under postoperative care. Anesthesia time is a continuous time period from the start of anesthesia to the end of an anesthesia service. 

Each provider should document the start and end time of their service on the anesthesia record when it is different from the anesthesia start and end time for the case. This is very important to ensure the service is billed correctly. Whenever possible, relief should be provided by like providers. However, this is not possible for all groups. Example: A case was started by a doctor working alone at 8:00, a CRNA came into the case at 8:30, then the doctor left at 9:00, and a different doctor came in to relieve the CRNA at 10:00, with the case ending at 10:30. Unless each provider documents start and end times, the CRNA performing solo from 9:00 – 
10:00 probably would be missed. This could cause concurrency issues with other cases for the doctors. If the group intended to medically direct the CRNA, this example would need to be billed as a split claim with appropriate modifiers, even though the case started and ended with a physician personally performing. If the group does not medically direct CRNAs, the case would be billed with modifier QZ (CRNA service: without medical direction by a physician); the lesser service.
I hope it helps.


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