Anesthesia Coding Alert

Question: Anesthesiologist A medically directed a CRNA during the first portion of a Medicare patient's case (he wasn't medically directing any other staff). Anesthesiologist B relieved Anesthesiologist A. The CRNA also left, leaving Anesthesiologist B alone for the remainder of the case. How should I code the direction?Texas SubscriberAnswer: The answer will depend on whether your Medicare Administrative Contractor publishes Frequently Asked Questions. For example, if this is a Railroad Medicare patient, FAQs were published in June 2011 indicating that you should code based on how the case began. Once a case starts, it remains in that category despite changes in staffing or direction. In your scenario, report the case as medically directed for the entire time.Here's how: Append modifier QY (Medical direction of one certified registered nurse anesthetist [CRNA] by an anesthesiologist) to your physician's code, and modifier QX (CRNA service: with medical direction by a physician) to the [...]