Anesthesia Coding Alert

Question: We currently bill monitored anesthesia care (MAC) services by a CRNA. We submit 01992-QZ-QS-P2 for Medicare and 01992-QZ for all other payers. I recently received information from a coding instructor that we should be billing this instead:

• 01992-QZ-QS for Medicare
• 01992-QZ-QS-P2 for all other payers.

I'm trying to find supporting documentation somewhere online for this before we make the change. Can you confirm if this is correct?

California Subscriber

Answer: If you're coding for a solo CRNA, then you should be reporting 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) with either modifiers QZ (CRNA service: without medical direction by a physician) and QS (Monitored anesthesia care service). Modifier QZ shows the payer that the CRNA performed the service without medical direction from a physician; modifier QS shows the mode of anesthesia as MAC.

The coding instructor is correct about one change to your coding. Medicare does not pay for physical status so the P2 (A patient with mild systemic disease) for those cases. Include it on your claims for private payers in case they recognize P modifiers, although a P2 patient might not even need anesthesia, depending on the procedure.

As Noridian states, "Local anesthesia or minimal conscious sedation may be appropriate. Use of moderate sedation and Monitored Anesthesia Care (MAC) is usually unnecessary. Documentation must clearly establish the need for such sedation in the specific patient."