Anesthesia Coding Alert

Question: How do insurers reimburse for out-of-network claims when the case involves both CRNA work and physician medical supervision? Is it split 50/50 as in Medicare?Maryland SubscriberAnswer: The answer depends on your location and the payer in question. While many Medicare payers do reimburse at 50/50 for cases involving a CRNA and physician supervision, other don't. For example, the Indiana Medicaid website states, "Certified registered nurse anesthetists (CRNAs) and anesthesiologist assistants (AAs) are reimbursed at 60% of the allowable physician rate. Medical direction of two, three, or four anesthesia procedures is reported using modifier QK and is reimbursed at 30% of the allowable physician rate." The allowed payment will also vary according to whether the anesthesiologist was medically directing the case or medically supervising. Some insurers won't pay for both providers' services when the physician is medically directing. If your contract with the payer doesn't state how these cases are [...]