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Anesthesiologist/CRNA billing

  1. #1
    Default Anesthesiologist/CRNA billing
    Medical Coding Books
    I am billing for a group which consist of one anesthesiologist and 3 CRNA's. For all carriers except MCR, they will only pay the anesthesiologist and deny the CRNA, or sometimes they will deny the anesthesiologist and pay the CRNA. And they are only paying at a reduced rate. I am using Mod QK or QY with the anesthesiologist and Mod QX on the CRNA. I have been told to bill only the anesthesiologist to the other carriers with Mod QK or QY and to bill it "incident to"...is this correct? Please help we are at a complete loss.

  2. Default
    Have your CRNA's been credentialed and added to the contracts?

  3. #3
    Default
    Try using AA for anesthesiologist and QZ for CRNA's. That's how we were paid. Medicaid will not pay for CRNA's if they are the primary insurance carrier, but medicare will with thos modifiers. I hope that helps.

  4. #4
    Location
    Fort Wayne In
    Posts
    81
    Default
    If the anesthesiologist is the only one involved and not directing any other cases would you still bill with the AA.


    ROBIN AMSTUTZ CPC

  5. #5
    Default
    If the Anesthesiologist is providing medical direction for example for 2 to 3 cases you can not bill AA for all of them. The times are going to overlap.

    Your source on the incident to suggestion? I would review with them the Medicare Benefits policy manual. They do not state that this applies to anesthesia Medical direction or personally performed cases.

    http://www.cms.gov/manuals/Downloads/bp102c15.pdf

    I would review the denials, call on those denials, find out the real reason these are denying for the CRNA. Make a spreadsheet so you can have meeting with the facts straight on which carriers have which stance, and the compliance issues with trying use an incident to concept with anesthesia cases.

  6. #6
    Default
    Another thing you could do is if determine the carrier is not going to pay separately for the CRNA, you could look at a similiar cases that you billed to MCR and then you might find even though the carrier in question did not pay the CRNA portion, the part they paid for the anethesiologist is very similar or more then what MCR paid as QY/QK & QX on some EOBs that you pulled because the carrier's has a higher converison factor it still balances out when comparing to reimbursement you are getting from MCR even though the CRNA portion is not being paid by the carrier(s) in question.

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