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Local anesthesia being only monitored by CRNA

Karen Posted Fri 03rd of October, 2014 15:05:17 PM

When the provider provides a local to a patient performing services on and a CRNA just comes in to monitor a patient what would be the appropriate code to assign. Again the CRNA only is monitoring the patient i.e. blood pressure, EKG, pulse oximetry.

SuperCoder Answered Tue 07th of October, 2014 07:12:06 AM

Local anaesthesia is considered as part of the procedure being performed and is not separately reimbursable. Hence, you may not bill for above services performed by CRNA.

Thanks !!

Karen Posted Mon 13th of October, 2014 12:53:16 PM

I am being directed to CMS website by my physician indicating that the CRNAs service is billable per CMS guidelines.Please see below indications provider provided me for this stating its covered. Please help me establish how to respond back to this providers findings

As promised, I reviewed the 7/24/2014 Medicare Claims Processing Manual and will quote you the following on payment of Monitered Anesthesia Care

From Chapter 12

Physician / Nonphysician Providers , 50 Payment for Anesthesiology Services, I. Monitered Anesthesia Care

The Part B contractor pays for reasonable and medically necessary monitored anesthesia care services on the same basis as other anesthesia services. Anesthesiologists use modifier QA to report monitored anesthesia care cases. Monitered anesthesia care involves the intra-operative monitoring by a physician or qualified individual under the medical direction of a physician or of the patient's vital physiological signs in anticipation of the need for administration of the need for administration of general anesthesia or of the development of adverse physiological patient reaction to the surgical procedure. It also includes the performance of a pre-anesthetic examination and evaluation, prescription of the anesthesia care required, administration of any necessary oral or parenteral medications (e.g. atropine, demerol, valium) and provision of indicated postoperative anesthesia care.

Payment is made under the fee schedule using the payment rules in subsection B………………..

Note that Medicare provides payment to CRNA as we use him. Also, clarification of MAC through the years has established that the one providing the MAC be capable of going to general anesthesia at a moments notice…..our CRNA and our Operating rooms are equipped for this.

Karen Posted Mon 13th of October, 2014 17:35:07 PM

Also what if the CRNA provides the local anesthesia instead of the surgeon and is doing the preop and post op exam??? Is that billable???

SuperCoder Answered Mon 13th of October, 2014 23:54:34 PM

Monitored anesthesia care combines local anesthesia with administration of a combination of drugs for anxiolytic, hypnotic, amnestic, and analgesic effect. However, in your case CRNA is just monitoring the patient for local anesthesia which is not considered as Monitored anesthesia care.

Local anaesthesia is considered as part of the procedure being performed and is not separately reimbursable. Hence, you may not bill for local anesthesia service of CRNA.

Thanks !!

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