1. tia frisk
   Posted 3 months ago #
   

   What would be the proper code to use when billing for PICC line insertion performed by CRNA (certified registered nurse anesthetist)within hospital setting? 36569 was rejected by Medicare. Any help would be appreciated.

2. SuperCoder
   Posted 3 months ago #
   

   It is fairly common for nonphysicians, such as nurses, to insert PICC lines. Frequently, in a hospital setting the by the IV therapy team inserts the PICC line. You would not bill for PICC line insertions by non-physicians in the facility setting. The physician cannot bill for the PICC line insertion unless he personally places the catheter. Supervising a nurse in the hospital setting does allow billing for these services.
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   Also keep in mind that you need to know your state's rules for CRNA scope of practice. The CMS final rule in November 2001 followed years of deliberation and comment from the public and healthcare community. The ruling held up the federal requirement that a physician supervise CRNAs when caring for Medicare or Medicaid patients in hospitals, critical access hospitals, and ambulatory surgical centers. However, a governor can exempt any institution or the entire state from the supervision requirement if the action is determined to be in the best interest of the state’s citizens. The governor must consult with state’s boards of medicine and nursing (or their equivalents) and verify that the state’s laws and regulations allow independent CRNA practice.
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   States and hospitals are free to establish additional standards for professional practice and oversight as they deem necessary. Because of that, state regulations can be more stringent than federal requirements.
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   Some states give anesthesiologists the right to perform brain surgery, but hospitals won’t credential them to do so on a local level. In addition, a hospital must require physician supervision of anesthesia in order to participate with Medicare.
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   You may also need to consider a modiier on your CRNA claims. When you submit claims for CRNA service without medical direction, append modifier QZ (CRNA service; without medical direction by a physician) to the code. Otherwise, include the applicable modifiers on both the CRNA’s and anesthesiologist’s claims for medical direction:
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   QX -- CRNA service; with medical direction by a physician
   QK -- Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals
   QY -- Medical direction of one CRNA by an anesthesiologist.
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   I hope this helps.
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   Best,
   Leesa
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   Leesa A. Israel, BA, CPC, CUC, CMBS
   Executive Editor, The Coding Institute
   Manager, TCI Consulting & Revenue Cycle Solutions
   Email: leesai@codinginstitute.com
   http://www.codinginstitute.com

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