Wiki Moderate Conscious Sedation by CRNA

[missyah20]

Hello All! I am having some trouble with getting code 99144 pd by Medicare. My provider is a CRNA located in Iowa, WPS is our Medicare Carrier. He is doing moderate conscious sedation with Epidural injections(ex, 62311, 62310, 64475 ect). This charge is being denied by Medicare with the denial reason of "PMT adjusted when performed by prov of this specialty." Has anyone else received this denial? Is there something I can do to help get this pd by Medicare?

 

[deedeefronius]

Do you have the correct modifier QX to indicate it's being performed by a CRNA? Without it, you will be denied.

 

[EllieAnn]

A CRNA would not bill 99144. A surgeon who is performing let's say an EGD and gives anesthesia would report 99144. If the CRNA is administering anesthesia AND also giving the ESI - you can NOT bill for both servies. You would need 2 separate providers to billProvider A bills: 01992-59, and Provider B bills: 62311.At our facility our CRNA's never work alone. But our Dr's often perform these ESI's w/ another Dr administering the Anesthesia.

 

[missyah20]

The CRNA, in this case, is acting as the surgeon. They are providing the moderate sedation and personally performing the injection.

I did find something of interest in Medicare's IOM Publication 100-04, Chapter 12, Section 50.L where it states, "If the anesthesiologist or CRNA provides both the anesthesia service and the block or injection, then the anesthesiologist or CRNA may report the anesthesia service using the conscious sedation code and the injection or block."

Medicare has been telling me that the CRNA can't provide this service, but when I look at this it looks like they can. I just wanted to get some other perspectives on this. Thanks.

 

[nurse2010]

Yes. You are actually correct based on this guideline from Medicare. In fact, I just double checked the CCI edits, 99144 and 62311 can be billed together.

But again, you have to check in your state if the CRNA is allowed to perform these procedures. Here's a link in regard to the Medical -Surgical procedures performed by the CRNA -- 140.4.3 - Payment for Medical or Surgical Services Furnished by CRNAs