Anesthesia Coding Alert

Question: We sometimes use just CRNAs during surgery and report their service with a QZ modifier. One CRNA will work a certain amount of time then another CRNA will take over. We then bill for the two different CRNAs and their times. Insurance companies will sometimes require records documenting both CRNAs, but is there anything additional that needs done to get both paid for their service? One insurance company is telling us that an additional modifier is required, but we disagree (and they aren’t telling us what the modifier should be). Are we missing something?

Connecticut Subscriber

Answer: Only one claim would be filed for these services. Since the relieving CRNA is a “like” provider, there is no confusion over which modifier should be reported. If the CRNAs were both working without medical direction, the claim may be filed either in the name of the CRNA who started the case, or the CRNA who spent the longest time on the case. Medical record documentation should support the exact times that each of the CRNAs were involved in the case.