Anesthesia Coding Alert

Avoid the trap of reporting services with modifier Q6

One of your anesthesiologists takes extended leave because of illness, so the group hires a CRNA to fill in until he returns. Although she is technically working as a locum tenens provider, don't fall prey to reporting her services as such.

Clarify What -Locum- Means

Locum tenens providers are a growing segment of anesthesiologists, with physicians temporarily taking another anesthesiologist's place because of illness, pregnancy, vacation time or continuing medical education. HCPCS Codes allows you to easily distinguish these services by appending modifier Q6 (Service furnished by a locum tenens physician) to the anesthesia code for whatever service the locum provides.

Problems can arise from a coding perspective when the fill-in provider is a CRNA instead of a physician--and a coder mistakenly appends modifier Q6 to the claims. 

-We ran locum CRNAs for quite some time while we recruited physicians for our new structure,- says Lori Mehlbauer, credentials manager of Medical Center Anesthesiologists in Louisville, Ky. -We were told that filing CRNA claims with the locum modifier could--and would--trigger an audit.-

The reason: Modifier Q6's descriptor plainly identifies it for physicians, not CRNAs.

So if the descriptor plainly states -physician,- why do coders sometimes use it for other providers?

-It's hard to say why coders might tend to report Q6 even though they-re reporting for a CRNA instead of a physician,- says Donna Howe, CPC, with Anesthesiology Consultants of Eastern Connecticut in Manchester. -My guess would be they use Q6 when they can't find anything else to report.-

Watch for the Lone Exception

As is the case with many anesthesia coding scenarios, even rules that seem set in stone--such as not using modifier Q6 for a CRNA's services--can change in certain circumstances.

Georgia's Medicare carrier, Cahaba GBA, has a policy stating that you can report modifier Q6 for CRNA services in one situation: When the CRNA makes a locum tenens agreement with other CRNAs rather than physicians.

Example: A group of CRNAs contracts with you to supplement physician services. If one of the CRNAs goes on extended education leave, their group can hire another CRNA to replace her during that time. Because both sides of the agreement involve CRNAs (the hiring group, the replacement CRNA, and the person she's replacing), you can submit her claims under the regular CRNA's provider number with modifier Q6 and other applicable modifiers.

If you find yourself coding for cases like these, check your local guidelines regarding modifier Q6.

Focus on Other Modifiers Instead

Although you might not be able to report modifier Q6 for a locum-type CRNA, don't forget about other modifiers related to the CRNA's work. If you-re reporting services for Medicare or other carriers that require performance modifiers, be sure to append:

- QX--CRNA service: with medical direction by a physician
- QZ--CRNA service: without medical direction by a physician.

States have specific guidelines for the types of procedures CRNAs can perform and how you should report them. All states except New Hampshire have some requirements of physician supervision/direction of CRNAs, and some states (such as California) require CRNAs to work with an anesthesiologist, while others (such as Georgia) allow CRNAs to work either with an anesthesiologist or alone. Because of this, always verify the CRNA's involvement with a case before submitting your claims.

Credentialing Is Key

 If you have CRNAs joining your staff in a locum tenens capacity, get ready for extra paperwork. Although the CRNAs are contract workers with your group, Medicare and some private carriers require that you credential them.

-We have to treat them as an employee with Medicare and apply for a Medicare provider number,- says Rosie Johnson, also of Medical Center Anesthesiologists. -They are basically self-employed, but they-re a regular employee in Medicare's eyes.-

Credentialing is a time-consuming process and can seem like a waste for a CRNA who will only be with you for a few weeks. But if the locum likes your practice and has an opportunity to stay with your group, at least he is already credentialed.