Wiki CRNA question

[cmacpc]

I have some cases where the CRNA's do the preop evaluations, they do not assist on the cases. Would I be using the QZ on the CRNA charge or the QX, and the QY/QK on the Anesthesiologist charge? We are just starting to bill out the CRNA's and what a headache!

Thank for the input.

 

[LeslieJ]

If the CRNA is only seeing the patient(s) for pre-op H&P, this is included with the anesthesia procedure.

Bill for the person who is doing the anesthesia procedures by the following methodology:

Single Claims only:

1.) Anesthesiologist who is doing the procedure - AA
(Anesthesiologists can't direct or supervise CRNA and do the anesthesia case themselves with some minor exceptions. See the Relative Value Guide book or CMS for clarification on this if needed).

2.) CRNA without Medical Direction from the anesthesiologist and is doing the procedure - QZ

Dual Claims:

3.) Anesthesiologist who is Medically Directing the CRNA (up to 4 of them in total): the Anesthesiologist would get the QK modifier and the CRNA would get the QX on the cases

4.) If the anesthesiologist is medically directing only a single CRNA, you'd bill the anesthesiologist's charge with a QY modifier and the CRNA's charge would get the QX on the cases

5.) The anesthesiologist can't medically direct more than 4 CRNA, so they call that supervision. This is where the anesthesiologist's charge would get the AD modifier and the CRNA would get the QX

The H&P or pre-op assessment is included with the anesthesia services so there won't be a separate charge for it if the CRNA does the H&P and the anesthesiologist does the actual anesthesia case because you can't split out these services anyway. The exception to this rule is if the case ends prior to the administration of anesthesia and only the E/M is billed, and then you could bill under the CRNA who did the exam.

L J

 

[SWilliams804]

Thanks for the information Leslie!

Building off number 5 of the "dual claims" examples you listed -
What if an MD anesthesiologists supervises (doesn't meet criteria for medical direction) only 1-3 CRNAs? The anesthesiologist would bill with AD modifier and the CRNA would bill with QX modifier, correct?