Unusual Circumstances – CRNA and Anesthesiologist
In unusual circumstances, when it is medically necessary for both the CRNA and the anesthesiologist to be completely and fully involved during a procedure, full payment for the services of each provider is allowed. Each provider must submit documentation to support payment of the full fee. The physician would use the AA modifier and the CRNA would use QZ or the modifier for a non-medically directed case. Documentation must be submitted by each provider to support payment of the full fee.
One Procedure – Two Anesthesiologists or Two CRNAs
When the first anesthesiologist or the first CRNA starts an anesthesia procedure and he has to leave the patient to start another anesthesia procedure, and the procedure is then taken over by a second anesthesiologist or a second CRNA who then finishes the procedure, a claim should be submitted for the anesthesiologist or CRNA who spent the longest length of time with the patient. The amount of time reported on the Medicare claim should be the combined total time period of the procedure. Documentation should include the time spent with the patient for both the first and second anesthesiologist or CRNA.
Example:
The first anesthesiologist or CRNA spent 15 minutes with the patient.
The second anesthesiologist or CRNA spent 45 minutes with the patient.
The claim would be submitted for the second anesthesiologist or CRNA with 60 minutes for the entire time period of the procedure.
