Anesthesia Coding Alert

Question: Our gastroenterology office uses contracted CRNAs to provide anesthesia to our patients. We have no anesthesiologist available to medically direct, and our providers do not supervise the CRNAs. Am I correct in coding the 00740 or 00810 with the modifier QZ in this case? I’m getting conflicting information saying that I should be billing two separate charges, one with the AD modifier under the GI provider and one for the CRNA with a modifier QS. This does not seem correct to me because our providers are not anesthesiologists. What’s your advice?

Virginia Subscriber

Answer: Because the CRNAs are unsupervised, you’ll bill any anesthesia codes such as 00740 (Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum) or 00810 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum) with modifier QZ (CRNA service without medical direction by a physician).

Modifier QS (Monitored anesthesia care) is used when billing MAC anesthesia. Some payers also want you to report modifiers G8 (Monitored anesthesia care [MAC] for deep complex, complicated, or markedly invasive surgical procedure) or G9 (Monitored anesthesia care for patient who has history of severe cardio-pulmonary condition) when appropriate. The MAC modifiers can be reported by both anesthesiologists and CRNAs.

Modifier AD (Medical supervision by a physician: more than four concurrent anesthesia procedures) is appended to an anesthesia code when the anesthesiologist medically supervises four or more concurrent anesthesia procedures. Because your CRNAs are not being medically directed or supervised by a physician (anesthesiologist or GI), you will not need to submit a claim by a physician with modifier AD (anytime a claim is filed with modifier QZ, the AD modifier is not applicable – otherwise, the anesthesia services will be overpaid). You’ll only report the service for the CRNA with modifier QZ and any MAC modifiers as appropriate.