Anesthesia Coding Alert

Question: Over the weekend, we had one anesthesiologist and two Certified Registered Nurse Anesthetists (CRNAs) on call. One doctor was medically directing the two CRNAs, and the anesthesiologist was called for an emergency C-Section. Can the anesthesiologist still report medical direction if they were present for part of the case?

Maryland Subscriber

Answer: No — once the anesthesiologist leaves the two medically directed cases to personally perform a C-section, they lose medical direction status. Even if they were present for some portion of the case, they cannot meet the requirements for medical direction, which includes the physician remaining “physically present and available for immediate diagnosis and treatment of emergencies” per Section 50 of the Centers for Medicare & Medicaid Services’ (CMS’) Medicare Claims Processing Manual. Many payers follow this guidance, although they may have their own policy descriptions.

Remember: You will need to check with the payers to ensure they recognize a QZ (CRNA service: without medical direction by a physician) modifier for the CRNAs, which indicates the case was non-medically directed. Depending on the payer, you may receive a reduction in payment for the CRNAs’ services.