Anesthesia Coding Alert

Question: We bill for a small anesthesia group that includes two CRNAs. The providers say the CRNAs can only bill moderate sedation when they perform services for podiatry. One insurance company insists that we report an ASA code instead of sedation. How should we handle this? Ohio Subscriber

Answer: Verify whether the CRNAs are providing moderate sedation or monitored anesthesia care (MAC), because that makes a difference in your coding. If the CRNAs administer anesthesia (such as MAC with Propofol), you're correct in reporting an ASA code. Select the appropriate code and append modifier QZ (CRNA service: without medical direction of a physician) if the nurse works alone.

Anesthesia providers rarely administer conscious sedation, though the situation isn't impossible. If you verify that your provider administers conscious sedation and the insurance company wants ASA codes, get that directive in writing. At the very least, write a letter to the insurer that confirms your understanding of their billing instructions. Keep a copy for yourself and send the letter by a method you can track. Even if you don't get an answer from the insurer, you'll have documentation that you tried to confirm their coding guidelines.