Anesthesia Coding Alert

Question: Can a CRNA employed by the anesthesiologist perform pre-anesthesia evaluations? How should we report the case if the CRNA works for the hospital, but the anesthesiologist (who is in private practice) medically directs her?


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Answer: If the anesthesiologist employs the CRNA, she can perform pre-anesthesia exams if she and the physician both sign off on it--and if hospital policies allow it.

When your anesthesiologist medically directs a CRNA who's employed by the hospital, you-ll only bill for the anesthesiologist's service (the hospital bills for the CRNA).

Submit the appropriate anesthesia code for the procedure and append 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). Select the modifier based on the number of concurrent cases the anesthesiologist directs.

Because your group and the hospital will both file for the procedure, be sure the claims- procedure codes and time units match. The only difference should be the performance modifier--QY or QK for the anesthesiologist's claim, and QX (CRNA service: with medical direction by a physician) for the CRNA's claim.