Anesthesia Coding Alert

Question: We had a physician bill CPT^® 27096 and a CRNA bill 01992 with a QZ modifier for work during the same encounter. The documentation supports both billings, but someone in our office has asked if this billing is appropriate. I haven't been able to find anything stating that the two codes could not be billed together; nor have I found anything stating the CRNA can't bill without supervision since this was in an office setting. Any thoughts?  

Connecticut Subscriber

Answer: A CRNA and physician can work together on a case resulting in the CRNA providing the anesthesia and a separate provider (the anesthesiologist in your case) performing the procedure. There is no coding edit between the codes you mention. Both providers should be able to file their claims and be reimbursed, provided the documentation is in place.

• 27096 – Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed
• 01992 – Anesthesia for diagnostic or therapeutic nerve blocks and injections (when block or injection is performed by a different physician or other qualified health care professional); prone position
• QZ – CRNA service: without medical direction by a physician.

Two important notes: If the physician does not use fluoroscopic or CT guidance for the injection, report 20552 (Injection[s]; single or multiple trigger point[s], 1 or 2 muscle[s]) instead of 27096. Also remember that although edits might not exist between these codes, payers may not reimburse for anesthesia during a minorpain management procedure such as 27096. Verifythat you have sufficient documentation supporting the need for anesthesia and follow the individual payer's guidelines.