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AA/CRNA Medical Direction

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    Posted: 19 Sep 2009 at 11:42pm
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AA/CRNA Medical Direction

Anesthesiologists may be reimbursed for the medical direction of one, two, three, or four CRNAs (certified registered nurse anesthetists) or AAs (anesthesiologist assistants). This is only applicable during concurrent surgeries within a surgical suite. The concurrent surgeries do not have to involve ForwardHealth members.

Definition

Medically directed anesthesia services are those services performed by a CRNA or an AA and directed by an anesthesiologist. When a CRNA or AA is medically directed, the anesthesiologist is required to do all of the following (anything less is considered supervision):

   1. Perform the pre-anesthesia examination and evaluation.
   2. Prescribe the anesthesia plan.
   3. Personally participate in the most demanding procedures of the anesthesia plan,
       including induction and emergence, if applicable.
   4. Monitor at frequent intervals the course of anesthesia administered.
   5. Remain physically present on premises and available for immediate diagnosis and
       treatment of emergencies.
   6. Provide indicated post-anesthesia care.

The general oversight of a surgical suite is not reimbursable.

Medical Supervision (Non-Reimbursable)

Medically supervised anesthesia services are those services performed by a CRNA and supervised by the attending physician. Medical supervision of CRNAs is not reimbursable.

Procedure Codes and Modifiers

Claims for medical direction should indicate the appropriate anesthesia CPT (Current Procedural Terminology) procedure code with modifier "QY" (Medical direction of one CRNA by an anesthesiologist) or "QK" (Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals).

The medical direction of five or more CRNAs or AAs is not reimbursable.

When qualifying circumstances for anesthesia exist, the supervising anesthesiologist may receive additional reimbursement by submitting a claim for a qualifying circumstance.

Note: CRNAs and AAs may not receive additional reimbursement for qualifying circumstances.

Billing Example for Special Situation

In this example, the number of CRNAs being medically directed changes during surgery: an anesthesiologist begins a three-hour surgery directing one CRNA. After one hour, a second surgery begins and the anesthesiologist directs a CRNA for that surgery as well. Two detail lines of the claim should be used when billing for this example. The first detail line should indicate the appropriate anesthesia procedure code, modifier "QY," and a quantity of "60."

The second detail line should include the same procedure code as on the first line, but modifier "QK" should be used to represent the second CRNA. Because the doctor directed the two CRNAs for two hours, the quantity is "120."

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