Anesthesia Coding Alert

California's State Supreme Court passes on reviewing previous decisions.

The question of whether CRNAs can perform services without supervision continues, so be sure to stay abreast of the latest news in your state.

Case in point: Late in June, the California Supreme Court decided not to review the state's 2009 opt-out from Medicare's facility reimbursement rule requiring physician supervision of certified registered nurse anesthetists (CRNAs). Lower courts in the state had ruled that California law did not require physician supervision of CRNAs, so those rulings now stand uncontested.

"CRNA supervision is a Medicare condition of reimbursement to healthcare facilities, and California has never required supervision of nurse anesthetists," Joseph Janakes, CRNA, MSN, president of the California Association of Nurse Anesthetists, stated in a press release. "The courts' affirmation of the opt-out ... facilitates access to safe, cost-effective anesthesia care for all Californians, especially in rural and other medically underserved communities."

California was the fifteenth state to opt out of the federal supervision requirement for CRNAs. Two other states have since followed, bringing the total number of opt-out states to 17.

Coding perspective: Append one of the following modifiers to your CRNA's claims, depending on the circumstances:

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

The associated physician modifiers for CRNA direction or supervision are:

• Modifier QK -- Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals
• Modifier QY -- Medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist
• Modifier AD -- Medical supervision by a physician: more than four concurrent anesthesia procedures.