Anesthesia Coding Alert

Question: How should we bill for a certified registered nurse anesthetist (CRNA) who administers an epidural? Nebraska Subscriber Answer: Depending on the carrier, a CRNA can bill for his or her individual services. In doing so, you may append modifier -QZ (CRNA service) to the procedure code to demonstrate that a physician did not direct or supervise the CRNA.

For example, if the CRNA performs the epidural in the cervical or thoracic spine, the corresponding code would be 62318-QZ (Injection, including catheter placement, continuous infusion or intermittent bolus ... epidural or subarachnoid; cervical or thoracic; -CRNA service).

Many commercial carriers, however, do not recognize most modifiers related to CRNA services. And there are some others issues that coders and billers should be aware of. Some plans prohibit a CRNA from billing for individual services without being under the direction of an anesthesiologist (not the physician performing the surgery), except in an emergency. State laws and hospital by-laws are usually the source of these restrictions. If a CRNA administers an epidural in an emergency, make certain that the nature and the circumstances of the situation are thoroughly documented. To be on the safe side, check with your carriers regarding their policies and with any hospital that the CRNA may be associated with, and thoroughly review the laws in your state regarding CRNA services.