# CRNA billing-I am facing



## rmalik (May 9, 2011)

Hello,

I am facing great problems with CRNA billing. My provider is billing 64450, and other epidural injections for place of sercie hospital outpatient but not getting paid. he is getting denails that CRNA is not authorized to bill the codes.

Do we have to bill these CPTs under the physician's name?

Can somebody help or send me any specific guidelines for CRNA billing for surgery procedures.

Ravi


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## mitchellde (May 9, 2011)

If the physician did not perform the service you cannot bill under his/her name.  If the CRNA is not authorized to bill for those services then the physician will need to perform the service.  This is either a state law or a payer policy you might want to check and see.


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## JudyW (May 9, 2011)

rmalik said:


> Hello,
> 
> I am facing great problems with CRNA billing. My provider is billing 64450, and other epidural injections for place of sercie hospital outpatient but not getting paid. he is getting denails that CRNA is not authorized to bill the codes.
> 
> ...


You might want to go on CMS website and print the Anesthesia Manual.  Is the phsyician supervising the CRNA? You could bill under the physician for supervision.  Not seeing the record leave a lot of under answered questions.  You can also go on the Palmettos website and they have information available about CRNA billing.  If it is another carrier, contact the carrier and ask why they feel you should not be billing for the service as it was performed and how do they want it billed.  Hope this helps.


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## rmalik (May 26, 2011)

Thanks

I am getting denails for (CPT 64450 & 9921X - outpatient visits) my CRNA as "provider not authorized to bill the service" It started happening after the noridian news letter released on 03/17/2011.

Should i inform him that he cannot bill the services alone?
Your help will be greatly appreciated.
Ravi

Noridian Article regarding CRNA				
Certified Registered Nurse Anesthetists (CRNAs) may provide anesthesia and related services to Medicare patients consistent with their State scope of practice and training and privileges: hospital, Ambulatory Surgical Centers (ASC) or office as appropriate. In a like fashion, these practitioners also may insert arterial lines and draw blood gases, place peripherally inserted central lines and central venous catheters (PICCs and CVPs) since formal guidelines and instructions as well as skills assessment are provided to CRNAs during their training.
Epidural injections are reimbursed as part of the anesthetic management of a patient and for the induction and maintenance of obstetrical analgesia. In addition, if the CRNA is an Advanced Registered Nurse Practitioner (ARNP) or Clinical Nurse Specialist (CNS), or working incident to a physician or Non-Physician Practioner (NPP), epidural injections may be reimbursed as part of the physician's or NPP's (NP, CNS, and PA) management of a patient with chronic pain.
Chronic Pain 
Chronic pain is the common symptomatic manifestation of a wide range of underlying medical conditions. Widely diverse injuries and medical illnesses may directly damage the peripheral and/or central nervous system and ultimately involve multiple body systems and manifest as chronic pain. Chronic pain induces or is accompanied by significant effects on mood, brain, neuroendocrine and other bodily systems' function. Reasonable treatment of the chronic pain disorder begins with a detailed medical assessment aimed at developing a diagnosis or diagnostic evaluation plan which will then lead to an appropriate and comprehensive therapeutic plan.
The comprehensive therapeutic plan may include interventional pain techniques, such as, epidural blockade. The assessment skills required for the evaluation of the chronic pain state and consequent therapy are not part of the CRNA training curricula. There are no guidelines or skills assessment available for development of the necessary medical diagnostic and therapeutic skills for CRNAs.


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## michedv50 (May 21, 2014)

*Obstetric Physicians Billing of Epidural during labor and vaginal delivery*

I am a CPC in AZ working for a large informatics/analytics organization. I am being asked a question regarding a provider who is billing a vaginal delivery along with 01927 for the epidural. He is using modifier QZ. QZ of course indicating that a CRNA did the service. Can the provider bill that out or should it be the CRNA only if within there scope of practice? I realize of course that the provider can bill if he supervised the CRNA. If that proves to be the case in the notes, how is that billed in most cases?


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## hgolfos (May 21, 2014)

A QZ indicates that the CRNA was unsupervised.  Not sure from your information who is actually placing the labor epidural.  CRNA scope of practice and billing will be dictated by state laws, and payer guidelines.  So, a lot depends on where you are and the payer you're billing.  

At any rate, if your OB provider bills out a claim with a QZ it will be denied, since he/she is not a CRNA.


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