Anesthesia Coding Alert

Question: We sometimes use just CRNAs during surgical procedures and append modifier QZ to the claims. One will work a certain amount of time, then another CRNA (whose service also qualifies for modifier QZ), will take over. We then bill for each CRNA and their individual time. Insurance companies will sometimes require records documenting both CRNAs, but is there anything else we should be doing to get both providers paid? One insurance company is telling us that an additional modifier is required, but we disagree. What are we missing?

New Hampshire Subscriber

Answer: You need to establish a policy within your practice for how to handle the billing and coding for these situations. It’s not uncommon to bill the entire procedure under one CRNA instead of trying to split the claim. For example, some practices bill under the CRNA who is in the case the longest; other practices bill under the CRNA who handles anesthesia induction since that usually is the most intensive portion of the procedure.

Actual reimbursement for each CRNA would then be handled internally rather than based on the insurer. Again, this will depend on whatever policy your practice puts into place. You can split the total reimbursement based on each CRNA’s time, or you can keep track of how often each CRNA receives “credit” for a procedure to be sure it evens out between providers over time.

However you decide to report the procedure, append modifier QZ (CRNA service: without medical direction by a physician) to the CRNA’s claim to document that the service was not associated with a physician’s medical direction.