Anesthesia Coding Alert

Question: Our anesthesiologists often split time in surgery. One of our anesthesiologists spent two hours medically directing a certified registered nurse anesthetist (CRNA), then another hour performing the case alone. What is the appropriate way to bill the anesthesiologist's and the CRNA's time?

Maryland Subscriber

 
Answer: If the CRNA and anesthesiologist are involved in a single case and the anesthesiologist is providing medical direction, the service should be submitted using two modifiers:
 

For single medically directed services on or after Jan. 1, 1998, the physician should report modifier -QY (medical direction of one CRNA by an anesthesiologist).
 

The CRNA should report modifier -QX (CRNA service: with medical direction by a physician).
 
Under current Medicare processing guidelines, if the CRNA is under the medical direction of the anesthesiologist, the anesthesiologist and anesthetist are paid an equal share of the medical direction allowance for their services if the appropriate modifiers are attached to the anesthesia code. The anesthesiologist is reimbursed one-half of the fee he or she would have received if the service had been performed personally, and the medically directed CRNA receives the other half.
 
Documentation should show exactly what happened, when the CRNA left the room and when the physician took over. This documentation can be as simple as an initialed note on the anesthesia record or as complicated as dictating an addendum to the record (as long as the physician signs off on the record).