Anesthesia Coding Alert

Question: The anesthesiologist began an ICD (implanted cardiac defibrillator, also called automatic internal cardiodefibrillator or AICD) implant on a Medicare patient; the case also involved a CRNA. The physician left for more than an hour to start another case alone. How should I report the anesthesiologist's and CRNA's time on the initial case? Will each have a charge?

Pennsylvania Subscriber
 
Answer: The anesthesiologist cannot work on a separate case when he is medically directing or supervising a CRNA because he is no longer constantly available for emergencies or frequent checks on the supervised/directed case. Report the first case with modifier -QZ (CRNA service: without medical direction by a physician) or modifier -AD (Medical supervision by a physician: more than four concurrent anesthesia procedures) if the physician meets the supervision requirements.