Anesthesia Coding Alert

Question: In our state a nurse anesthetist can provide care under the supervision of or under a collaborative agreement with a surgeon or another specialty when an anesthesiologist is not present to provide medical direction. The nurse anesthetist receives 100 percent of the allowed amount for cases reported with modifier QZ. Our anesthesiologist, however, is saying that the nurse anesthetist cannot perform the service if the anesthesiologist is not medically supervising or medically directing. Can you offer any advice?

New Jersey Subscriber

Answer: In unusual circumstances when it is medically necessary for both the anesthesiologist and nurse anesthetist/ anesthesiology assistant to be fully and completely involved during a procedure, each provider is allowed to collect full payment for the service. This, however, is the exception rather than the rule.

Laws vary from state to state regarding cases when the nurse anesthetist is the sole anesthesia provider. In some states, the nurse anesthetist can work without physician supervision; in other states, physician supervision/ direction is required. When supervision is required, this can be provided by either an anesthesiologist or a non-anesthesiologist physician (such as the surgeon). In that situation it is correct to bill the nurse anesthetist’s service with modifier QZ (CRNA service: without medical direction by a physician) as you have been doing. The anesthesiologist will not receive payment when they are not providing medical supervision nor medical direction.

Tip: Even if the state allows CRNAs to work under another physician, keep in mind that the you should also check hospital bylaws, delineation of privileges and/ or malpractice insurance to ensure supervision by an anesthesiologist is not required.