Friday, October 21, 2016

BILLING Guide for CRNA Anesthesia services with example

Certified Registered Nurse Anesthetists (CRNA) Services 

Neighborhood will require all CRNA(s) to become individually credentialed

Effective 10/1/2014 Neighborhood will begin reimbursing CRNA services at a percentage of anesthesia allowable. CRNA must be credentialed on the date of service in order to receive reimbursement for the service and all claims must be billed using the CRNA’s NPI as rendering provider
.
When a CRNA and a medically directing anesthesiologist provide services for a single anesthesia procedure, submit claims as follows:

· Submit separate claims for each practitioner using his/her NPI number
· Submit the same CPT procedure code and time on both claims
· Add to the procedure code on the supervising anesthesiologist’s claim:

Modifier Description 
QY Medical direction of one CRNA by an anesthesiologist
· Add to the procedure code on the medically directed CRNA’s claim:

Modifier Description 
QX CRNA service; with medical direction by a physician
-Payment would be 50 percent of the allowable amount of the service to the anesthesiologist and 80 percent of the anesthesiologist’s payment will be paid to the CRNA.

Example: 

Procedure XXXX allowable is $100.00
Anesthesiologist payment is $50.00
CRNA payment is $50.00 x 80% = $40.00
When an anesthesiologist medically directs or supervises more than one CRNA  submit claims as follows:

· Submit separate claims for each practitioner using his/her NPI number
· Submit the same CPT procedure code and time on both claims
· Add to the procedure code on the supervising anesthesiologist’s claim:



Modifier Description 
QK Medical direction of 2,3, or 4 concurrent anesthesia procedures.
· Add to the procedure code on the medically directed CRNA’s claim:

Modifier Description 
QX CRNA service; with medical direction by a physician
-Payment would be 50 percent of the allowable amount of the service to the anesthesiologist and 80 percent of the anesthesiologist’s payment will be paid to the CRNA. 

Example: 
Procedure XXXX allowable is $100.00
Anesthesiologist payment is $50.00
CRNA payment is $50.00 x 80% = $40.00

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