Anesthesia Coding Alert

Question: The majority of our facilities use only certified registered nurse anesthetists (CRNAs). My question is, are they considered under the direction of the surgeon performing the procedure (QX), or are they considered nonmedically directed (QZ)?

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Answer: The short answer is that if the insurance company accepts HCPCS Level II modifiers, the CRNA is considered nonmedically directed in these cases where an anesthesiologist is not present in the operating room. For billing purposes, this is an important distinction because modifier QX (CRNA service: with medical direction by a physician) typically reduces payment to half of the allowed amount.

Don’t miss: For compliance purposes, make sure the facility (under the CRNA’s delineation of privileges), state nursing board (varies by state), and malpractice insurance allow nonmedically directed CRNAs to provide services without an anesthesiologist’s oversight.

While states may allow surgeons to oversee the CRNA, surgeons are not allowed to bill separately for that anesthesia service. Another consideration is that the surgeon is not qualified to take over the anesthesia case in the event of an anesthetic emergency and may not even be aware they are responsible for oversight of the anesthesia case.