Anesthesia Coding Alert

Question: Two of our anesthesiologists participated in a patient's multiple trauma case, including providing critical anesthesia care. Can we bill for both providers' participation (with supporting documentation)? 


Oklahoma Subscriber


Answer: Medicare allows you to bill for both providers, so you have a good chance of being able to file both anesthesiologists' services with other carriers.

Submit separate claims for each physician according to the services he provided and the time he spent with the patient.

If the carrier requires HCPCS modifiers, report each physician's service as personally performed (AA, Anesthesia services performed personally by anesthesiologist). Then add modifier 22 (Unusual procedural services) to each physician's claim to show the unusual circumstances. Include a cover letter of explanation and copies of the anesthesia record when you submit a claim with modifier 22.

If a CRNA also helped with the case, report HCPCS modifier QZ (CRNA service: without medical direction by a physician).

Watch it: You won't report modifier QX (CRNA service: with medical direction by a physician) because that contradicts reporting the anesthesiologist's service as personally performed. 

The carrier will probably have questions because you're reporting a case with unusual circumstances. Submitting your claim with a cover letter explaining the situation might help prevent a possible denial.