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CRNA Billing


Lewiston, ME
Best answers
I'm reviewing CRNA services for Anthem, Medicare and Medicaid; could anyone share some information on CRNA billing for in- and outpatient services for Anthem, please? Does BCBS Anthem require that CRNAs bill their services on a UB or 1500? I'm seeing it done both ways and it appears inconsistent with their policy that these should be billed on Form 1500s.

Additionally, if the type of anesthesia administered is MAC, then converted to general, would you only code the general anesthesia?

Any guidance will be helpful; thank you for your time.



Best answers
A bit late here, but I'll answer what I can.

I think all of our CRNA claims go out on 1500s, regardless of payer. I mean I don't know for sure, as I'm not the only coder at my employer, but I haven't fielded any questions from other coders on the job about UBs, and none of my bosses has berated me for failing to bill with a UB, so make of that what you will. Perhaps our billing software or clearinghouse is super smart and is doing something in the background to convert some 1500s to UBs without my knowledge - it's possible I guess. But I don't think so.

The way the types of anesthesia were explained to me initially, it was a hierarchy, with general at the top, regional/epidural/spinal in the middle, and MAC/local at the bottom. I was told to always bill for the "highest" anesthetic that was used, regardless of how brief. So in the example you cited, you would bill for general, because it is usually the most complex service type, and thus reimbursed at a higher rate.