Anesthesia Coding Alert

Question: Are anesthesia assistants the same as a CRNA in regard to billing? For example, if an anesthesiologist is medically directing one CRNA and one anesthesia assistant, do we consider their services the same when assigning modifiers to the claims and use the QK modifier for the physician and QX modifier for both the CRNA and anesthesia assistant? If not, how should we bill for the anesthesia assistant?

Vermont Subscriber

Answer: Anesthesiologist assistants work under direct supervision of an anesthesiologist performing support functions that don't require the skills of a doctor, while ensuring doctors are there in case an emergency arises. As you suspect, the same modifiers apply to anesthesia assistants as CRNAs.

In the situation you describe, you would also append modifier QX (CRNA service: with medical direction by a physician) to the anesthesia assistant's claim. An important distinction is that an AA might not provide services as non-medically directed modifier (QZ, CRNA service: without medical direction by a physician), whereas a CRNA might, depending on the state in which they practice. If the AA was working on a one-to-one ratio, a QY modifier (Medical direction of one certified registered nurse anesthetist [CRNA] by an anesthesiologist) should be reported.