Friday, 20 January 2017

Anesthesia Billing for CRNAs

When filing claims through the Medicare program and the CRNA is employed by the anesthesiologists, reimbursement for “medically directed” by an anesthesiologist and “non-medically directed” are revenue neutral - meaning reimbursement is equal to the same amount.  

For example, when medical direction modifiers “QK and QX” are reported (see table below), reimbursement is divided equally (50% and 50%) between the physician and the CRNA.  When a CRNA is non-medically directed, full reimbursement (100%) is paid. It is a misconception that an MD/CRNA care team must report Medicare modifiers to all insurance companies, and doing so may cause reimbursement problems.  

Not all carriers recognize separate claims or Healthcare Common Procedure Coding System (HCPCS) modifiers!  

Many private insurers expect CRNA services to be billed under the anesthesiologist, on one line of the claim form. Reporting separately may result in a claim denial or improper payment.  An additional confusion, since many practices generally equally split the full amount of the bill between the physician and CRNA, is that the claim is viewed as a duplicate.  

Although Medicare pays the CRNA and anesthesiologist equal shares, other carriers may not pay the separate charge, leaving your patient with a large out-of-pocket expense.

One way to avoid confusion when you must bill two claims, i.e. to collect a Medicare secondary balance, is to charge different amounts for the physician and CRNA.  

For example, in our practice we assigned 70% of the conversion factor to the physician and 30% to the CRNA; however, your practice may choose to assign a different value.    

Assigning different values when claims must be split helps identify and separate the services of the physician and the CRNA, as well as decrease odds the claims will be mistaken as duplicate.  It is important to remember, however, not to assign a CRNA value so low that the submitted charge is less than the allowed or expected amount!

How can you tell when to send separate claims?  

One clue is to determine whether a separate provider number is needed, such as Tricare, which does credential CRNAs. To receive payment from carriers that require two claims, the CRNA must have a valid provider number and have reassigned their benefits.  It is important to ensure the provider number is valid before the CRNA begins working.  

Many practices lose revenue by their inability to bill certain insurances, such as Medicare and Medicaid, for a CRNA whose number is not yet in place, such as temporary providers.  Although short-term contract or temporary CRNAs are called “locum tenens,” the locum tenens modifier is not intended to be used to bill for their services.

In most instances, CRNAs are prohibited from using the Q6 modifier to receive payment, since by definition the modifier indicates the service was provided by a “physician.” However, as to be expected in the anesthesia world of billing, there are no “absolutes”! Georgia Medicare published policy in September of 1999, which specifically allows use of the Q6 modifier by CRNAs. 

Keep in mind, though that without written permission this is generally not an acceptable use of the Q6 modifier.

base units of Anesthesia cpt code - list 2
CPT CODES and BASE UNITS
CPT CODES and BASE UNITS
00930 4
00932 4
00934 6
00936 8
00938 4
00940 3
00942 4
00944 6
00948 4
00950 5
00952 4
01112 5
01120 6
01130 3
01140 15
01150 10
01160 4
01170 8
01173 12
01180 3
01190 4
01200 4
01202 4
01210 6
01212 10
01214 8
01215 10
01220 4
01230 6
01232 5
01234 8
01250 4
01260 3
01270 8
01272 4
01274 6
01320 4
01340 4
01360 5
01380 3
01382 3
01390 3
01392 4
01400 4
01402 7
01404 5
01420 3
01430 3
01432 6
01440 8
01442 8
01444 8
01462 3
01464 3
01470 3
01472 5
01474 5
01480 3
01482 4
01484 4
01486 7
01490 3
01500 8
01502 6
01520 3
01522 5
01610 5
01620 4
01622 4
01630 5
01634 9
01636 15
01638 10
01650 6
01652 10
01654 8
01656 10
01670 4
01680 3
01682 4
01710 3
01712 5
01714 5
01716 5
01730 3
01732 3
01740 4
01742 5
01744 5
01756 6
01758 5
01760 7
01770 6
01772 6
01780 3
01782 4
01810 3
01820 3
01829 3
01830 3
01832 6
01840 6
01842 6
01844 6
01850 3
01852 4
01860 3
01916 5
01920 7
01922 7
01924 6
01925 8
01926 10
01930 5
01931 7
01932 7
01933 8
01935 5
01936 5
01951 3
01952 5
+ 01953 1
01958 5
01960 5
01961 7
01962 8
01963 10
01965 4
01966 4
01969 5
01990 7
01991 3
01992 5

00100 5
00102 6
00103 5
00104 4
00120 5
00124 4
00126 4
00140 5
00142 6
00144 6
00145 6
00147 6
00148 4
00160 5
00162 7
00164 4
00170 5
00172 6
00174 6
00176 7
00190 5
00192 7
00210 11
00211 10
00212 5
00214 9
00215 9
00216 15
00218 13
00220 10
00222 6
00300 5
00320 6
00322 3
00326 8
00350 10
00352 5
00400 3
00402 5
00404 5
00406 13
00410 4
00450 5
00452 6
00454 3
00470 6 
00472 10
00474 13
00500 15
00520 6
00522 4
00524 4
00528 8
00529 11
00530 4
00532 4
00534 7
00537 10
00539 18
00540 12
00541 15
00542 15
00546 15
00548 17
00550 10
00560 15
00561 25
00562 20
00563 25
00567 18
00566 25
00580 20
00600 10
00604 13
00620 10
00622 13
00625 13
00626 15
00630 8
00632 7
00634 10
00635 4
00640 3
00670 13
00700 4
00702 4
00730 5
00740 5
00750 4
00752 6
00754 7
00756 7
00770 15
00790 7
00792 13
00794 8
00796 30
00797 11
00800 4
00802 5
00810 5
00820 5
00830 4
00832 6
00834 5
00836 6
00840 6
00842 4
00844 7
00846 8
00848 8
00851 6
00860 6
00862 7
00864 8
00865 7
00866 10
00868 10
00870 5
00872 7
00873 5
00880 15
00882 10
00902 5
00904 7
00906 4
00908 6
00910 3
00912 5
00914 5
00916 5
00918 5
00920 3
00921 3
00922 6
00924 4
00926 4
00928 6



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