Anesthesia Coding Alert

Question: Our CRNA administered a lumbar epidural steroid injection. How should I code this, and should I include modifier -QZ (CRNA service: without medical direction by a physician)?

Oklahoma Subscriber

Answer: If the CRNA administered the epidural for pain management purposes, code it as 62311 (Injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; lumbar, sacral [caudal]).
 
If the epidural is for an obstetrics patient, report 01967 (Neuraxial labor analgesia/anesthesia for planned vaginal delivery [this includes any repeat subarachnoid needle placement and drug injection and/or any necessary replacement of an epidural catheter during labor]).
 
States have specific guidelines for the types of procedures CRNAs can perform and how to report them. For example, some states direct you to use modifiers -QZ or -QY (Medical direction of one certified registered nurse anesthetist [CRNA] by an anesthesiologist) only in particular situations, but other states request them more often. Check your local guidelines about whether to include modifier -QZ.

 - You Be the Coder and Reader Questions were reviewed by Cindy Smith, CPC, anesthesia coder with Professional Healthcare Billing Services in Charleston, W.V.