Q&A Office Anesthesia Billing

[Karla]

Last year, I passed my CPC exam on the first try with help from the Blitz DVDs and was hired by an oculoplastic surgeon. My physician always uses contract CRNAs and charges patients a flat fee to cover these services when surgeries are performed in the office, so no charges are filed on claims and submitted to insurance.

He is interested in billing anesthesia for the medically necessary surgeries to insurance and asked me to research this. I watched the anesthesia blitz and still have questions.

1. With CPT 00103 using a CRNA, do we use modifier QX as well as the physical status modifier?
2. Also, are two separate claims required, one for the physician, for example with 15823 -50 modifier and one for the CRNA 00103 -P1, -QX?

I hope I've made this clear enough for you to follow. Any help would be greatly appreciated!

Thanks in advance for your guidance,
Karla

 

[Alicia Scott]

I am not sure about this Karla but I do know others who would be able to give you advice. Let me check with them. In the mean time there may be others that just know that are already here. Don't forget that the payer has some say here. If you are dealing with more then one I would contact them and confirm what they want done.

 

[Karla]

Thanks for looking into this Alicia, I'm at a loss here. Yes, we would be billing different payers. I don't understand if the QX is only used for anesthesiologists or ANY doctor (such as our surgeon). So much to learn and some things are difficult to find info on. Look forward to hearing what you find out.
Thank you!

 

[Laureen]

Yes we need to find you an anesthesiology coding expert. I would also suggest you join the supercoder specialty group

CLICK HERE

NEWSLETTER YOU DOC MAY PAY FOR

FREE EMAIL LIST TO JOIN

 

[Karla]

Thanks for the suggestions Laureen...those do look like some good places for for the future, if we decide to go that way. However, at this point my physician doesn't want to pay money to gather a little info to help determine if billing anesthesia would be practical.

If you come across anybody that can give a bit of guidance, please send them my way. I would sure appreciate it.

Karla

 

[Dorothy]

Karla,

I bill for an anesthesia practice. We go to plastic surgery centers and use CRNA's. The surgeon bills his stuff and we bill our CRNA's to insurance...now if this is considered cosmetic depending on the surgeon they either take our money up front or send the patient to our office to prepay for services. We would bill the procedure ASA code plus time increments with QZ modifier and physical status.

Now if we are at the hospital and we have a DR with CRNA on a case we would use either QY/QK for the DR depending on the number of cases running and a QX for our CRNA. Now if the CRNA is working independently with surgeon we would bill QZ as he is not being supervised an anesthesiologist.

 

[Karla]

Karla,

I bill for an anesthesia practice. We go to plastic surgery centers and use CRNA's. The surgeon bills his stuff and we bill our CRNA's to insurance...now if this is considered cosmetic depending on the surgeon they either take our money up front or send the patient to our office to prepay for services. We would bill the procedure ASA code plus time increments with QZ modifier and physical status.

Now if we are at the hospital and we have a DR with CRNA on a case we would use either QY/QK for the DR depending on the number of cases running and a QX for our CRNA. Now if the CRNA is working independently with surgeon we would bill QZ as he is not being supervised an anesthesiologist.

Hi Dorothy,

Thanks so much for responding! You are just the person to help a totally confused newbie! Is there a way of speaking with you privately as I'm working through this, perhaps by email? Our office will only code one particular way for all of our cases and I just have a few more questions to thoroughly understand the requirements.

One of the questions, to clarify, is a CRNA considered working independently if he comes to our OFFICE and works with our plastic surgeon, no anesthesiologist on premises? Or because our surgeon (a DR) is there, is the CRNA considered working under a doctor? I'm sorry, but still a bit confused. In regards to these modifiers, does DR only refer to anesthesiologists?

Thank you so much!!!
Karla