Anesthesia Coding Alert

Question: We are starting to report medical direction cases. Will we report our total billed amount to Medicare with the medical direction modifiers for each provider? For example, if the total bill is $900, should we send in $900 with the CRNA modifier and $900 with the anesthesiologist’s medical direction modifier? Or do we bill each at roughly half price?

Nevada Subscriber

Answer: It would not be appropriate to bill $900 for each provider, as that would double the amount of your billed anesthesia conversion factor. Your anesthesia charges should equal the same amount, whether the service was medically directed or personally performed. So if you’re filing a $900 claim to Medicare for the medical direction of a certified registered nurse anesthetist (CRNA), the anesthesia charges should be shared between each provider.

In the example provided, presuming the medical direction criteria were met and documented, you could bill the CRNA claim in the amount of $440 with modifier QX (CRNA service: with medical direction by a physician), and the anesthesiologist’s claim in the amount of $460 with either modifier QY (Medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist) or QK (Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals).

Note: The allocation is up to the anesthesia practice.

Even though Medicare will pay each provider 50 percent of the allowed amount, your practice may choose to assign a different ratio to the charges to be able to determine which charge belongs to the CRNA and which charge belongs to the physician. Assigning a different amount will also keep the claim from being inadvertently viewed as a duplicate charge and make posting payments much easier. Insurance companies have become much better at understanding medical direction modifiers, although not all payers require reporting them.

If the payer does not accept medical direction modifiers and the claim is not shared or split, You would bill the entire amount, in this example, $900, under the name of the physician who employs the CRNA.