# Anesthesia billing for EGD - I have been reading



## gina_marie

I have been reading separate threads but none really seem to address what I need.  I have never done anesthesia billing so totally new to this.  

Our GI doctor needed to bill anesthesia for a couple of weeks for in office procedures.  They hired a CRNA to administer it.  She documented her time so we have all the necessities needed for billing.  However, when we billed 00810 and 00740, the insurance company bundled the price of those into the 45678 procedure code.  We billed with the QZ modifier.  

Is there another modifier we have to use for the procedure or the anesthesia to get it billed?  How do we get reimbursed for this?  

If anyone can help, my email is gsavarino@e-mds.com.  I would appreciate any assistance!  

Thank you, 
Gina Savarino, CPC


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## dabroussard

I think the problem is the code includes the anesthesia.  I do not think, since this is a bundled service you can legally unbundle it.


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## rleuken2k

*Anesthesia*

I tried to locate the code 45678 but could not find it.  I looked in 3 years of CPT books from 2010-2012.  Can you tell me what the procedure is because I am really anxious to know what this code is used for.    I am wondering if the procedure has anesthesia bundled already into the code.  You may want to read the guidlines for that subject.  Also, did she provide services without the help of an anesthesiologist.  If not then you would have used the QY mod.

I am looking forward to reading your reply


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## gina_marie

Sorry - typo.  CPT 45378 - diagnostic colonoscopy.  I guess I will need to do more research into the codes including the anesthesia.  If that is the case, can the physician bill for reimbursement for the drug then?  

As far as the modifiers go - we understood (as well as read via a Medicare anesthesia manual) that QY is Medical Supervision by Physician of one CRNA - to be used when the anesthesiologist supervises a CRNA while QZ is CRNA Service without Medical Direction by a Physician - anesthesia provided by CRNA without medical direction by a physician. 
The only physician on duty was the GI doctor who was doing the procedures only so the CRNA was the one administering and documenting the anesthesia use.  

Thanks, 
Gina


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## hgolfos

Did you mean 45378?  We bill anesthesia for colonoscopies in many different states.  

1. It may depend on the payer.  Some payers don't pay for CRNA services.  

2. Are you billing under the CRNA's provider number on a separate claim, and not the surgeon's?

3. When billing for anesthesia you can only bill one ASA code plus time, so you should bill either 00810 or 00740 with time and the QZ mod.

4. Some payers consider anesthesia for colonoscopies not medically indicated because the surgeon can usually provide adequate sedation, this can be circumvented however, if your patient has an underlying medical condition that necessitates anesthesia.  Check with your payers for policies regarding anesthesia for endoscopy.


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## hgolfos

Sorry on number two I was not very clear... you should be billing under the CRNA's Name and number, not the surgeon's.


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## gina_marie

hgolfos said:


> Did you mean 45378?  We bill anesthesia for colonoscopies in many different states.
> 
> 1. It may depend on the payer.  Some payers don't pay for CRNA services.
> The one we did bill was UHC and they bundled the services.
> 
> 2. Are you billing under the CRNA's provider number on a separate claim, and not the surgeon's?
> We thought it was supposed to go on the claim with the procedures.  Do we need to bill it separately?  (Like I said, we are new at this - noone in my office has ever billed anesthesia before!)
> 
> 3. When billing for anesthesia you can only bill one ASA code plus time, so you should bill either 00810 or 00740 with time and the QZ mod.
> If an EGD and colonoscopy were done at the same time, do we need to bill the anesthesia codes for each procedure on a different claim?  We went ahead and filed the procedures so we wouldn't miss filing deadlines.  Now we just have the anesthesia codes to bill and there were 2 patients out of the 11 that our GI doc did the anesthesia for that had both an EGD and colonoscopy done at the same time.
> 
> 4. Some payers consider anesthesia for colonoscopies not medically indicated because the surgeon can usually provide adequate sedation, this can be circumvented however, if your patient has an underlying medical condition that necessitates anesthesia.  Check with your payers for policies regarding anesthesia for endoscopy.
> I don't believe many, if any, had any underlying conditions.  Most were just screenings that were done.



This stuff is so confusing when you have never done it before and don't have anyone on hand to help you out!  Thank you for your assistance though - it has kind of given me some idea of where else I may need to search.


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## hgolfos

1. It may depend on the payer. Some payers don't pay for CRNA services. 
The one we did bill was UHC and they bundled the services. 

To my understanding UHC does cover CRNA's

2. Are you billing under the CRNA's provider number on a separate claim, and not the surgeon's?
We thought it was supposed to go on the claim with the procedures. Do we need to bill it separately? (Like I said, we are new at this - noone in my office has ever billed anesthesia before!) 

Yes, you should bill separately under the CRNA's name and number. You may need to enroll your CRNA with the insurance company as a provider. If you bill the anesthesia and the surgery on the same claim it looks like your surgeon is performing both, which isn't allowed. The CRNA is qualified to provide and bill for services.

3. When billing for anesthesia you can only bill one ASA code plus time, so you should bill either 00810 or 00740 with time and the QZ mod.
If an EGD and colonoscopy were done at the same time, do we need to bill the anesthesia codes for each procedure on a different claim? We went ahead and filed the procedures so we wouldn't miss filing deadlines. Now we just have the anesthesia codes to bill and there were 2 patients out of the 11 that our GI doc did the anesthesia for that had both an EGD and colonoscopy done at the same time. 

With anesthesia it doesn't matter how many procedures were done in the operating session, you still can only bill one ASA code. The proper coding is to choose the ASA code with the highest base units and bill base units + time + physical status or clinical circumstance X per unit rate. So all colonoscopies and EGD's are 5 base units. let's suppose your procedure takes 1 hour from start to stop (billed in 10 or 15 minute increments depending on carrier) and you are charging $75 per unit. you would bill 

*00810 OR 00740 *

5 (base ) + 6 (time) x $75 = $825. 

If you have a physical status of 3 you would add one unit to the total. 5 + 6 + 1 x $75

You are charging for providing anesthesia not carrying out the procedures... so you can't bill more than one code.

4. Some payers consider anesthesia for colonoscopies not medically indicated because the surgeon can usually provide adequate sedation, this can be circumvented however, if your patient has an underlying medical condition that necessitates anesthesia. Check with your payers for policies regarding anesthesia for endoscopy. 
I don't believe many, if any, had any underlying conditions. Most were just screenings that were done.

You may or may not get paid for these.  The main insurance we have the issue with is Blue Cross.  You can check with them and get their criteria to see if your patients meet any of them.


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## Davieda Skobel

We bill CRNA's in Louisiana and Texas who do MAC for colonoscopies and EGD's in endoscopy centers and we have found that most insurance companies have a policy regarding these. the CPT 45378 and most endoscopies have conscious sedation built right into the code discription so you need a "medical necessity" code to warrent the "extra anesthesia and monitoring".There are a list of codes that justify "medical necessity for MAC anesthesia" in TrailBlazer's LCD for "Monitored Anesthesia Care", we find that most insurance companies follow this list. The key to the whole reimbursement for anesthesia during an endoscopy is that insurance companies believe that the Gastroenterologist should be doing "conscious sedation" for the procedure unless there is a good reason for extra monitoring and sedation.I battle constantly with the insurance companies and if you don't tell the patients ahead of time that the anesthesia may not be covered, you cannot bill the patient in most cases!!!!  Good luck! I'm happy to help you if you need more info.
Davie CLPN,CPC Columbus,Ohio.:


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## jsantos

*2 CRNA 1 Case*

I was reading the post and I have a question. CRNA Y started a case and then CRNA Z finished her case and came in the middle of CRNA Y case to finish the case. Though, CRNA Y went an started another case. So how do I bill 2 CRNA's performing one case?  Thank you in advance for your help.


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## gmohammad

*gulshan*

i am sure you can split the time for both CRNA as long as modifier qk,qy is used.


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## yadiaguilar

*Anesthesia billing question-PLEASE HELP!*

I do billing for a Fertility Dr. and was asked to bill claims for a Anesthesia Dr. that we use for our outpatient cases. Does that Anesthesia Dr. have to be an employee of the Fertility Clinic I work for, for me to bill for him as a courtesy? Also he would like the insurance payments to be sent to our Fertility office billing address on the HICFA under the billing provider info. I added our company name however he would like his group NPI added under our facility name. Can i legally do that since the billing provider mentioned on claim has a different NPI #?


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## jmcmillan

hgolfos said:


> 1. It may depend on the payer. Some payers don't pay for CRNA services.
> The one we did bill was UHC and they bundled the services.
> 
> To my understanding UHC does cover CRNA's
> 
> 2. Are you billing under the CRNA's provider number on a separate claim, and not the surgeon's?
> We thought it was supposed to go on the claim with the procedures. Do we need to bill it separately? (Like I said, we are new at this - noone in my office has ever billed anesthesia before!)
> 
> Yes, you should bill separately under the CRNA's name and number. You may need to enroll your CRNA with the insurance company as a provider. If you bill the anesthesia and the surgery on the same claim it looks like your surgeon is performing both, which isn't allowed. The CRNA is qualified to provide and bill for services.
> 
> 3. When billing for anesthesia you can only bill one ASA code plus time, so you should bill either 00810 or 00740 with time and the QZ mod.
> If an EGD and colonoscopy were done at the same time, do we need to bill the anesthesia codes for each procedure on a different claim? We went ahead and filed the procedures so we wouldn't miss filing deadlines. Now we just have the anesthesia codes to bill and there were 2 patients out of the 11 that our GI doc did the anesthesia for that had both an EGD and colonoscopy done at the same time.
> 
> With anesthesia it doesn't matter how many procedures were done in the operating session, you still can only bill one ASA code. The proper coding is to choose the ASA code with the highest base units and bill base units + time + physical status or clinical circumstance X per unit rate. So all colonoscopies and EGD's are 5 base units. let's suppose your procedure takes 1 hour from start to stop (billed in 10 or 15 minute increments depending on carrier) and you are charging $75 per unit. you would bill
> 
> *00810 OR 00740 *
> 
> 5 (base ) + 6 (time) x $75 = $825.
> 
> If you have a physical status of 3 you would add one unit to the total. 5 + 6 + 1 x $75
> 
> You are charging for providing anesthesia not carrying out the procedures... so you can't bill more than one code.
> 
> 4. Some payers consider anesthesia for colonoscopies not medically indicated because the surgeon can usually provide adequate sedation, this can be circumvented however, if your patient has an underlying medical condition that necessitates anesthesia. Check with your payers for policies regarding anesthesia for endoscopy.
> I don't believe many, if any, had any underlying conditions. Most were just screenings that were done.
> 
> You may or may not get paid for these.  The main insurance we have the issue with is Blue Cross.  You can check with them and get their criteria to see if your patients meet any of them.



I am having the same problem with UHC.  Our CRNA's are listed as providers with them but they are still bundling the codes and stating that they are following CMS guidelines and that we cannot bill 45378 for the physician and 00810 for the CRNA if they fall under the same tax ID.  Any clue how to fight this?


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