Anesthesia Coding Alert

Answer: Assuming the anesthesiologist is medically directing one certified registered nurse anesthetist (CRNA) rather than supervising, and that all seven aspects of medical direction have been met and documented by the anesthesiologist, the anesthesiologist uses the -QY modifier (medical direction of one certified registered nurse anesthetist [CRNA] by an anesthesiologist) to show that he or she was covering the CRNA one-on-one for the entire case. The CRNA reports with the -QX modifier (CRNA service: with medical direction by a physician) to show medical direction.

So for the cataract case, the anesthesiologist would bill code 00142-QY (anesthesia for procedures on eye; lens surgery) at six units for the procedure (according to the American Society of Anesthesiologists[ASA] Anesthesia Crosswalk) and four units of time (four 15-minute time blocks equal 60 minutes for the case). The CRNA would bill code 00142-QX, also with six procedure and four time units. Each member of the team receives half of the Medicare unit value of the total charge so that the total charge is the same as if the anesthesiologist personally performed the procedure.