Anesthesia Coding Alert

Question: When my physician performs a pain management procedure, and a CRNA administers the anesthesia, I bill the CRNA with a QZ modifier. Our workers' comp carrier says this is incorrect. What should I do differently?

Pennsylvania Subscriber

Answer: As the procedurist (surgeon), your anesthesiologist cannot supervise the CRNA. Therefore the CRNA cannot be medically directed by your anesthesiologist doing the procedure. In this case, if the CRNA is directed by another anesthesiologist, then modifier QX (CRNA service: with medical direction by a physician) is appropriate.

If the CRNA is not being directed by another anesthesiologist, then only the CRNA will be billing for anesthesia. This is indicated with modifier QZ (CRNA service: without medical direction).

Your scenario describes a case where the CRNA is not medically directed. If allowable by state law, hospital policy and worker comp rules, then QZ is the most appropriate. It might be denied because many companies do not pay for anesthesia for some procedures, believing that adequate sedation can be done by the surgeon and a nurse (conscious sedation) and thus not generating any anesthesia bill.