Part B Insider (Multispecialty) Coding Alert

Locum tenens physicians can be a great solution if one of your doctors is away or on maternity leave. But if you have a certified registered nurse anesthetist go away, you may be out of luck.

Medicare doesn't allow you to bill for the services of a substitute CRNA using your existing CRNA's number, laments Kimberly Dues with Mass Medical Billing in Dickinson, TX. The only thing you can do is credential the substitute CRNA as quickly as possible so you can bill for his or her services - or else eat those costs.

"There needs to be some type of solution for CRNAs when they have to fill in,"
says Dues, who works with anesthesiology practices. Medicare should come up with a separate modifier for non-physician practitioners, similar to Q6, she suggests. The problem is that when a substitute CRNA comes in, the practice must pay the agency for his or her services, but then the practice doesn't receive any reimbursement.

"It's a real issue and Medicare has not addressed it and they need to," says Dues. All over the country, the number of anesthesiologists has dropped for the past few years, while the number of new CRNAs has gone up. But the inability to bill for a substitute CRNA's services is a major drawback, says Dues.