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CRNA being denied a duplicate

  1. #1
    Default CRNA being denied a duplicate
    Medical Coding Books
    I am billing for an Ohio Anesthetist the following:
    mod QY when the Anesthetist supervises one CRNA
    mod QK when the Anesthetist supervises two CRNA

    I am getting denials from MMO, Anthem, Aetna, UHC and MCR sometimes on the CRNA stating it is a duplicate and sometimes they deny the anesthetist stating duplicate. Is there another modifier I should be using?
    Last edited by neecen; 09-28-2010 at 09:27 AM.

  2. #2
    Location
    Sioux Falls South Dakota
    Posts
    358
    Default
    Quote Originally Posted by neecen View Post
    I am billing for an Ohio Anesthetist the following:
    mod QY when the Anesthetist supervises one CRNA
    mod QX when the Anesthetist supervises two CRNA

    I am getting denials from MMO, Anthem, Aetna, UHC and MCR sometimes on the CRNA stating it is a duplicate and sometimes they deny the anesthetist stating duplicate. Is there another modifier I should be using?
    For the anesthesiologist (MD) use:
    QY when supervising one CRNA procedure
    QK when supervision two, three or four concurrent CRNA procedures

    For the CRNA, use:
    QX when supervised (medical direction) by a physician
    QZ without medical direction by a physician.

    If you are using QX on the anesthesiologist, that is incorrect.

    Hope this helps,
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  3. #3
    Default
    Lucinda, this is a big help. Thank you so much.

  4. Default
    I am also being denied for dup i bill for 1 procedure and use qx qs for crna I am located in NY... I am also getting denials saying that the plans don't cover crna's and was told by a oxford rep to bill under the MD once with qyqs and again w/ qxqs can this be right? please help
    Quote Originally Posted by cmcgarry View Post
    For the anesthesiologist (MD) use:
    QY when supervising one CRNA procedure
    QK when supervision two, three or four concurrent CRNA procedures

    For the CRNA, use:
    QX when supervised (medical direction) by a physician
    QZ without medical direction by a physician.

    If you are using QX on the anesthesiologist, that is incorrect.

    Hope this helps,

  5. #5
    Default
    came across your post, was wanting to know, are you billing JUST for crna? or is your practice anesthesiologist/crna?

    if you are billing ONLY for crna, you would use qz only
    if you are billing anesthesiologist/crna, you use qk/qx
    if you are billing anesthesiologist/crna and its one to one ratio you bill qy/qx

    if your group is crnas only, the md cannot bill anesthesia codes, they are there just for supervision only., ie-surgeron is overseeing crna.

    hope this helps

  6. Default
    Thank you for your help

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