Anesthesia Coding Alert

Question: Our CRNA documented that she administered an epidural steroid injection under anesthesia at an ASC. Can we bill for this?

Rhode Island Subscriber

Answer: If anesthesia was medically necessary, you can bill for anesthesia during diagnostic or therapeutic nerve blocks and injections although the medical record should clearly document the reason anesthesia was needed. The American Society of Anesthesiologists (ASA) has a Statement on Anesthetic Care During Interventional Pain Procedures for Adults that indicates sedation is not typically necessary for epidural steroid injections. If the documentation supports medical necessity, be sure to append the correct performance modifier for the CRNA, depending on whether the service was medically directed:

• QX – CRNA service: with medical direction by a physician
• QZ – CRNA service: without medical direction by a physician.

If the service was medically directed, append the appropriate modifier to the anesthesiologist’s claim as well: 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 place of service as 24 for the ASC.

Note: Some payers may not allow this service to be billed under an ASC claim due to their own insurance policy. Check the payer’s policy to file the claim correctly.