Anesthesia Coding Alert

Question: The anesthesiologist supervised with a CRNA in one surgery room, then left to perform a pre-op block that would be the next patient's primary anesthesia. He returned to supervising the first case. How should we report the anesthesiologist's time? North Dakota Subscriber

Answer: Several state carriers have published information making it clear that the anesthesiologist can place arterial lines or pre-op blocks for one patient while medically directing another patient's case. If the physician met medical direction criteria, report his time and service with modifier QY (Medical direction of one certified registered nurse anesthetist [CRNA] by an  anesthesiologist) or QK (Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals) as appropriate. Append modifier QX (CRNA service: with medical direction by a physician) to the CRNA's claim.

Different angle: If the anesthesiologist had been the only provider with the first patient and left to administer the second patient's block, you'd be looking at discontinuous time when he returned to the first case. In that situation, count the blocks of time the anesthesiologist spent with the patient before and after leaving to place the pre-op block.