Anesthesia Coding Alert

Question: I have a CRNA who practices solo at a surgery center doing cataract anesthesia for Medicare patients. I have been unable to get Medicare to pay a peribulbar block. I reported 01991 with modifier QZ and Medicare denied my claim for the modifier. I billed again without a modifier and Medicare denied that claim also. How should I report the block?

Oklahoma Subscriber

Answer: Your CRNA isn't providing anesthesia to place the block, so steer clear of 01991 (Anesthesia for diagnostic or therapeutic nerve blocks and injections [when block or injection is performed by a different provider]; other than the prone position). Instead, she is providing anesthesia for the cataract surgery.

Report the cataract anesthesia service with 00142 (Anesthesia for procedures on eye; lens surgery) and append modifier QZ (CRNA service: without medical direction by a physician). Your CRNA may be able to bill discontinuous time for the block if she is actually placing it; however, the peribulbar block isn't separately billable. The Correct Coding Initiative bundles the block (67500, Retrobulbar injection; medication [separate procedure, does not include supply of medication]) into the anesthesia service (00142) and does not allow a modifier to unbundle the code pair.

Caution: Your CRNA must be careful to bill only for the documented time spent with the patient. Cataracts are sometimes handled in such a way that the block is placed and the CRNA leaves the patient to go to another. The CRNA's time cannot overlap -- that is, she cannot be in more than one place at one time.