Anesthesia Coding Alert

Question: What would be the most accurate way of coding for general anesthesia performed by a CRNA during surgery of the knee joint?

Louisiana Subscriber

Answer: The appropriate code for this type of surgery is 01400 (Anesthesia for open or surgical arthroscopic procedures on knee joint; not otherwise specified).

If the CRNA works one-on-one under the anesthesiologist's medical direction, use modifier QY (Medical direction of one certified registered nurse anesthetist [CRNA] by an anesthesiologist).

If you're billing for a CRNA under your anesthesiologist's medical direction, use modifier QX (CRNA service: with medical direction by a physician).

If the CRNA performed alone, use modifier QZ (CRNA service: without medical direction by a physician).

Keep in mind: Not all insurance companies recognize HCPCS modifiers, although Medicare carriers require these HCPCS modifiers for correct payment.

For example: HCPCS modifiers can include AA (Anesthesia services performed personally by anesthesiologist), QS (Monitored anesthesia care service), or QX (CRNA service: with medical direction by a physician).

Tip: In past years, Medicare carriers did not accept physical status modifiers (P1-P6). However, some carriers are beginning to ask for P modifiers.