Anesthesia Coding Alert

Question: Can you help me understand how insurance companies process a 50/50 split when the anesthesiologist and CRNA both submit separate bills for services? if the industry standard allowable amount is 50 percent, do I have to write off the remaining 50 percent or can I bill the patient that amount?

South Carolina Subscriber

Answer: In these situations, you bill the full amount under each provider and a contracted insurer pays 50 percent to each provider, totaling 100 percent of the allowed amount. You would write off the rest to avoid “double dipping.”

The insurer assumes you’re billing the full amount, so takes the reduction. If the provider takes the reduction up front, the insurer doesn’t know this and you’ll have too much taken from the intended allowable. Its falls under the premise that the physician and the CRNA share responsibility for providing the services so each gets a portion of the payment.

Another point: Some payers will accept a single claim with only the physician name and two lines for services, one for the AA (Anesthesia services performed personally by anesthesiologist) modifier indicating the physician’s work and one for the CRNA’s Q- modifier.