CRNA Billing in ASC

kzwicker

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We are adding an anesthesia group to our billing office that uses non-medically directed CRNAs. I have been billing for groups who direct their CRNA's and this are my first experience with non directed CRNAs. I have research the contracted insurance carriers and I know how they want these claims billed. My issue is with all the other carriers, which I would normally bill physician only with AA modifier, or no modifier when the CRNAs are directed. At the ASC the anesthesiologist is present in the facility at all times. Even though this group states they do not direct their CRNA's can I bill with the anesthesiologist name and NPI number? My concern is the non-contracted carriers might not agree to pay non-physician providers.
 

LeslieJ

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I just have one thing to say about your question: to bill ANY services under a provider's name/number, etc. could very well be considered the F-word.

You are telling the carriers that the provider is the anesthesiologist, when in fact, it is not.

CRNAs may be credentialed like any other provider, and for non-medically directed cases, we can use the -QZ modifier just fine for carriers. They can even apply for and receive an NPI #. Although I do not code/bill for ASC, I haven't seen very many times when a carrier would refuse payment to a non-medically directed CRNA with this modifier.

I must use a disclaimer here: it's quite possible that someone else has - but there may be a myriad of reasons for this.

Be very careful about reporting services under names/ID# that do not belong to the correct provider.

Leslie Johnson, CPC
http://www.askleslie.net
 

kzwicker

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That is the answer I was expecting. Just looking for some reassurance. Has anyone seen any issue with the carriers who require the AA modifier only when billing with the CRNA?
 
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Hi, i do coding for a CRNA based group, you cannot use a -AA modifier if there is no anesthesiologist present in the operating room. The group i do the coding for does not have a physician in the room, most carriers do pay for a crna based group. You can apply for individual provider numbers, although, depends on your local medicaid, they may or may not pay. We run into that issue with pennsylvania welfare, they will provide a provider number, but will not pay because its "not a medical plan benefit"

The only modifiers you can use for a CRNA based group are -QZ & -QS. AA will not apply unless you have a dr/crna in the operating room. We also do billing for a big corporation that is dr/crna, we have very few problems getting these claims paid. Our software is setup to automatically put the modifiers on the claims, very few times we have to add.

If you have any other questions, please do not hesistate to contact me.
 
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