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09135 and 01936

Deana Posted Fri 08th of March, 2019 09:27:43 AM
During our kyphoplasty procedures (22513/22514), we have a CRNA who providers MAC anesthesia to the patient in the prone position typically using propofol. The surgeon handles the procedures and supervises the CRNA. Would 01935 and 01936 be the appropriate codes to bill for the anesthesia component? Also, does it get billed under the surgeon or under the CRNA (on the same or separate claim form)? The CRNA does a complete anesthesia history and physical on the day of the procedure and the surgeon/practice PA does a separate H&P as well. Are either of these separately billable? Does 01935 and 01936 bill in 15 minute increments, and if so, how do we code that? Also, can we bill for medications or are they inclusive with the main codes? Our CRNA wants to bill 99156/99157 with modifiers QX, P3 and 22 (if applicable). Would this be appropriate and, if so, is there a particular order? When would we use these codes, if ever?
SuperCoder Answered Mon 11th of March, 2019 08:13:56 AM

Thank you for your Question.

 

CPT code 01936 would be appropriately billable. This service would be billed under CRNA on separate claim with modifier QX. Medication codes are HCPCS codes which will be reported separately along with anesthesia services.

As per CMS, If the anesthesiologist or CRNA provides both the anesthesia service and the block or injection, then the anesthesiologist or CRNA may report the anesthesia service and the injection or block. However, the anesthesia service must meet the requirements for moderate sedation and if a lower level complexity anesthesia service is provided, then the moderate sedation code should not be reported.

Refer the undermentioned CMS article for more detail.

https://www.cms.gov/regulations-and-guidance/guidance/transmittals/2017downloads/r3747cp.pdf

 

Hope this Helps!

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