Anesthesia Coding Alert

Question: Is there any way to bill for two anesthesiologists working on one case?

Connecticut Subscriber

Answer: Yes, as long as both anesthesiologists are medically necessary for the case and document the specific anesthesia services they are providing. Several resources support two providers on a case-by-case basis and not just for two anesthesiologists. At the beginning of the ASA Relative Value Guide^® (RVG), the anesthesia guidelines indicate, “The necessity of assistance by a second anesthesiologist should be substantiated by a special report indicating the circumstances that required the need for two physicians.”

The Centers for Medicare and Medicaid Services (CMS) Medicare Claims Processing Manual also addresses what to do when “the physician and the CRNA (or anesthesiologist’s assistant) are involved in one anesthesia case and the services of each are found to be medically necessary. Documentation must be submitted by both the CRNA and the physician to support payment of the full fee for each of the two providers. The physician reports the AA [Anesthesia services performed personally by anesthesiologist] modifier and the CRNA reports the QZ [Crna service: without medical direction by a physician] modifier.”

Using this same logic, if the services of two anesthesiologists are medically necessary and the documentation supports this, each physician would report the appropriate code and append modifier AA to bill for their services.