Anesthesia Coding Alert

Question: My anesthesiologist started a case at 12:13 p.m. The certified registered nurse anesthetist (CRNA) came in about 30 minutes later. The anesthesiologist was pulled away to supervise another case 20 minutes later (at 1:03 p.m.), so the CRNA finished the case at 1:20 with the attending physician. Since the CRNA was not present for the entire case, how should I report this?

Indiana Subscriber

Answer: Your question doesn't specify the patient's insurance or who employs the CRNA -- both key factors in determining the correct way to report this procedure. We'll assume your anesthesiologist and CRNA are employed by the same group.

In this case, you would have to append modifier QZ (CRNA service: without medical direction by a physician) for the CRNA's services since the anesthesiologist was not directing her.

Alternative: You could also use QX (CRNA service: with medical direction by a physician) for the CRNA and AD (Medical supervision by a physician: more than four concurrent anesthesia procedures procedures) for the anesthesiologist, because after 1:03 p.m. the anesthesiologist was not able to provide all of the components necessary to prove medical direction.

If you send a split claim to your payer (that is, an anesthesia claim in the name of the physician and another in the name of the CRNA), you cannot report anesthesia services as both medically directed and personally performed. If you bill this way using QX and AD, understand that it will result in a significantly decreased reimbursement.

Caveat: If you bill the claim to an insurance company that does not require medical supervision modifiers and the group employs the CRNA, you may report in the physician's name without any modifiers --if additional information is required, documentation will support who provided the services.