Anesthesia Coding Alert

Question: One of our carriers wants us to split-bill for a case involving a CRNA and the anesthesiologist. How should I correctly report the fee for each provider?

Virginia Subscriber

Answer: First, report the CRNA and anesthesiologist's services on separate lines and be sure to append the correct modifiers to the procedure codes. Add modifier -QX (CRNA service: with medical direction by a physician) to the CRNA's portion and either modifier -QK (Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals) or -QY (Medical direction of one certified registered nurse anesthetist [CRNA] by an anesthesiologist) as appropriate (depending on whether the case qualifies for medical supervision or medical direction).

Second, determine how the carrier wants you to report the fee. Some carriers require you to split the fee 50-50 between the providers, but others prefer to allocate a larger percentage to the anesthesiologist (such as some Blue Cross/Blue Shield carriers that want you to divide it 80-20). Check the carrier's guidelines to make claims processing easier.