Billing Guide - Two anesthesiologist performed

One Procedure – Two Anesthesiologists or Two CRNAS

If one practitioner begins the anesthesia and has to leave the patient to start another procedure and a second practitioner finishes the procedure the one who is with the patient that spent the longest time with the patient can bill. That practitioner should report the combined total of minutes. Documentation must support the time spent by both practitioners.

Pain Management

Covered pain management services provided by anesthesia practitioners should be billed using the most appropriate CPT code. Modifiers AA, AD, QK, QX, QY or QZ should not be used. Neither should physical status modifiers P1 through P6 be used.

Types of Pain management includes the following:

• Post Operative pain management placement of epidural

• Post-operative pain management – daily hospital management of epidural (continuous) or subarachnoid (continuous) drug administration

• Should only be billed on post-operative days and not on the same day as the operative procedure

• Number of units should be billed not anesthesia time


Conscious Sedation

Conscious sedation is an altered level of consciousness that allows a patient to still respond to physical stimulation and verbal commands, and to maintain an unassisted airway. Conscious sedation is typically considered a part of the surgical procedure global package and not reimbursed separately.

In some cases however, a patient’s condition may warrant the use of conscious sedation with procedures where sedation is not normally used. This may include children, acutely agitated patients, or acutely ill patients who cannot have the procedure without sedation. The procedures included in this category that may require IV monitoring by an anesthesiologist include  ndoscopies, arteriograms, CT scans, MRIs, cardiac catheterizations, and PTCA