Anesthesia Coding Alert

Question: Will insurers (including Medicare) pay for a certified registered nurse anesthetist (CRNA) and an anesthesiologist for the same procedure on the same day? If so, how would you bill for both? Do you need to use any modifiers?

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  Answer: When an anesthesiologist and anesthetist are both involved in a single anesthesia service, the service is considered personally performed by the anesthesiologist (using HCPCS modifier -AA, anesthesia services performed personally by anesthesiologist). No separate payment is ordinarily recognized for the anesthetists services. You may be able to get reimbursed for the services of both professionals in very special cases, however, if you carefully document the medical necessity of having both providers present. For example, you should be able to get paid for a ruptured aneurysm when both professionals are needed throughout to manage the patient. In such a case, you would bill the appropriate procedure code with modifier -QY (medical direction of one CRNA by an anesthesiologist) for the physician and the procedure code with modifier -QX (CRNA service: with medical direction by a physician) for the CRNA.