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GYN physician billing for Monitored Anesthesia Care (MAC)

Cathy Posted Thu 05th of September, 2019 14:18:05 PM
We are a gynecology provider performing office based gynecologic surgery. We are utilizing the services of a CRNA who is not under the supervision of an anesthesiologist. The CRNA is under the medical direction of the rendering physician. How would we go about billing for monitored anesthesia care (MAC) (example: CPT 00952 during a hysteroscopy (CPT 58558) if the CRNA is not a participating provider under our accepted insurance groups?
SuperCoder Answered Fri 06th of September, 2019 07:22:19 AM

Hi,

 

Thanks for your question.

 

 

If the CRNA has NPI number and is contracted by insurance companies you can bill under their own NPI. 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) with anesthesia code.

 

If the CRNA is not a participating provider under your accepted insurance groups, then payment for CRNA will not get reimbursed.

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 (Advance Beneficiary Notice) if they would like to continue with the use of a CRNA.

Some insurance companies do not credential CRNAs, so you will need to contact your insurance companies prior to taking on the CRNA billing.

 

Hope this helps!

 

Thanks

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