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billing for crna

Terry Posted Tue 12th of February, 2019 14:06:11 PM
Our practice is hiring a crna to assist with endoscopy. The payment and billing npi is the group/practice npi. Can the gastroenterologist who is performing the procedure bill for the anesthesia under his npi and we use the practice npi as the billing npi so payment comes to the practice? If so, would he bill the egd or colonoscopy charges on one claim form and then put the anesthesia charges on a separate claim with a modifier ? if the crna is an employee of the practice and is under direct direction and supervision of the gastroenterologist during the egd or colon he is performing and the payment for anesthesia services should come to the practice, would it be on different claim forms? Is there a modifier? and does the crna npi HAVE to be used or can the Gastroenterologist bill under his NPI?
SuperCoder Answered Wed 13th of February, 2019 04:30:29 AM

Thanks for your question.


Billing will be determined by several factors. If the CRNA has a NPI# and is contracted by insurance companies you can bill under their own information. You will need to apply the appropriate modifier to the claim. Examples of those modifiers are:

-QZ (CRNA service: without medical direction by a physician) indicates that an anesthesiologist did not medically direct the CRNA during the case.

If the CRNA was medically directed, report modifier:

-QX (CRNA service: with medical direction by a physician)

-QY (Medical direction of one certified registered nurse anesthetist [CRNA] by an anesthesiologist) instead, depending on the situation.


If the CRNA administered MAC, also report modifier -QS (Monitored anesthesia care service).


You will also need to append your status indicators to the claim:


-P1 No documentation of special conditions is needed for patients classified as P1 and the insurance company is not billed any additional charges.


-P2 No documentation of the condition is needed for P2 patients either and the carrier is not billed. Mild forms of anemia or other conditions can qualify a patient for P2 status. Smoking also can qualify a patient as P2 because caregivers and carriers assume that he has some degree of lung disease.


-P3 Patients classified as P3 may have severe anemia hypertension diabetes or a mild heart lung or circulatory disease. A patient who smokes and has lung disease that is life-threatening would also be P3.


-P4 These patients have moderate to severe cases of respiratory distress trauma shock sepsis or other heart lung or circulatory disease. Unstable angina cardiogenic shock active pulmonary disease or increased intracranial pressure are a few examples of P4 conditions.


-P5 Patients in the P5 category have severe heart respiratory or circulatory disease or major trauma such as an MVA (motor vehicle accident) or MCA (motorcycle accident). Other conditions including septic shock ruptured aneurysm postoperative bleeding and loss of consciousness may also qualify for P5 classification if the immediate postoperative prognosis is grave.


If your CRNA has no contracts with insurance companies or NPI#, they will have to bill under medical direction. You will need to have both signatures on the documentation. You will also need to document that the case was under medical supervision. Append the appropriate modifiers and status indicators to your claim. Some insurance companies will not allow this, and some do not credential CRNAs, so you will need to contact your major insurance companies prior to taking on the CRNA billing.


If the insurance plan does not cover the use of a CRNA, you will need to notify the patient and have them sign an ABN if they would like to continue with the use of a CRNA. Some practices have other alternatives to the use of CRNAs such as RNs to provide other anesthesia care.




if the CRNA is an employee of the practice and is under direct direction and supervision of the gastroenterologist during the EGD or colon he is performing and the payment for anesthesia services should come to the practice, would it be on different claim forms?


As per CMS If an employer-physician furnishes concurrent medical direction for a procedure involving CRNAs and the medical direction service is unassigned, the physician should bill on an assigned basis on a separate claim for the qualified nonphysician anesthetist service. If the physician is participating or takes assignment, both services should be billed on one claim but as separate line items. Find undermentioned links for more information.

Hope this Helps!

SuperCoder Answered Fri 15th of February, 2019 06:23:30 AM

Generally, MAC (Monitored anesthesia care) is administered to patients undergoing EGD and colonoscopy procedures by Gastroenterologists. Gastroenterologists do not bill for anesthesia services. MAC has separate CPT codes and those are billed, when MAC is administered by gastroenterologists. If gastroenterologist is billing for anesthesia service for these procedures, physician would have to provide the medical necessity documents to support the need for extra anesthesia and monitoring.


Also, reimbursement for anesthesia services for EGD and Colonoscopies differ from payer to payer. Some payers may pay for the anesthesia services others may not, as they consider anesthesia services for these procedures as not necessary. Payers would consider anesthesia service included in the procedure code when billed by the provider. Please check with your payer regarding rules, regulations and guidelines related to Endoscopic and colonoscopy procedures.


If provider (gastroenterologist) is sure about billing anesthesia services for EGD and Colonoscopy, claim should be billed separately for anesthesia service under the CRNA name and number. You need to get the CRNA credentialed and include her in your #TIN (group practice) and then bill the anesthesia services for endoscopy and colonoscopy under her NPI. 

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