Anesthesia Coding Alert

Question: A medically directed CRNA administered anesthesia for a labor patient, and the anesthesiologist personally performed anesthesia during the resulting cesarean section. How should I report this case for a carrier that requires split claims? 


Minnesota Subscriber


Answer: Once a case begins as medically directed, it remains that way for the entire procedure. The simplest way to submit the claim is with a form for each provider.
 
On the first form, report the CRNA's involvement with 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]) and modifier QX (CRNA service: with medical direction by a physician). Include the appropriate number of time units for the CRNA's service.

On the second form, report the anesthesiologist's involvement in the first part of the case with 01967 and the modifier reflecting the level of medical direction (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).

Report +01968 (Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia [list separately in addition to code for primary procedure performed]) with modifier AA (Anesthesia services performed personally by anesthesiologist) for the cesarean section. Divide his time units between the   two codes.

You Be the Coder and Reader Questions were answered by Tonia Raley, CPC, claims processing manager for Medical Information Systems in Phoenix.