Billing for Medical Direction
When an anesthesiologist medically directs the services of a CRNA or AA, it is recommended that two separate claims should be submitted using the same CPT code and the same amount of time on each claim with the appropriate modifiers. In unusual circumstances, such as complicated trauma case, it may be necessary for both the CRNA and the anesthesiologist to be involved completely and fully in a single case. Both the CRNA and the anesthesiologist must submit documentation.
When the anesthesiologist does not fulfill all of the “medical direction” requirements, the concurrent anesthesia services are considered medical supervision services and are not considered medical direction services. In this instance, the claim should be submitted as a CRNA service with the “QZ” modifier.
Physical Status Modifiers-Physical status modifiers distinguish between various levels of complexity of the anesthesia service provided based on the patient’s condition, and are represented by the letter P followed by a single digit; Note: Physical status modifiers do not impact reimbursement rates.
P1 Normal healthy patient
P2 Patient with mild systemic disease
P3 Patient with severe systemic disease
P4 Patient with severe systemic disease that is a constant threat to life
P5 Moribund patient who is not expected to survive without the operation
P6 Declared brain-dead patient whose organs are being removed for donor purposes