CRNA and Anesthesiologist in a Single Anesthesia Procedure
When a single anesthesia procedure involves both a physician medical direction service and the service of the medically directed CRNA, the payment amount for the service of each is 50 percent of the allowance otherwise recognized had the service been furnished by the anesthesiologist alone. The CRNA should use the QX modifier. For the single medically directed service, the physician should use the modifier QY.
Payment for Anesthesia Services of Teaching CRNAs
A teaching CRNA who is not under the medical direction of a physician can be paid under Medicare Part B when continuously present and supervising a single case involving a student nurse anesthetist. In this single-case scenario, if the teaching CRNA is supervising a case performed by a student nurse anesthetist and is present with the student throughout the case, payment is made at the regular fee schedule rate. The CRNA should report the service using the usual QZ modifier, which designates that he is not medically directed by an anesthesiologist.
The American Association of Nurse Anesthetists (AANA) indicates that its standards for approved nurse anesthetist training programs allow a teaching CRNA to supervise two concurrent cases involving student nurse anesthetists. A teaching CRNA who is not under the medical direction of a physician can be paid under Medicare Part B when supervising two student nurse anesthetists. Prior to January 1, 2010, in this scenario, the CRNA has been paid in the following manner:
By recognizing the full base units (assigned to the anesthesia code) when the teaching CRNA is present with the student nurse anesthetist throughout pre- and post-anesthesia care.
By recognizing the actual time the teaching CRNA is personally present with the student nurse anesthetist.
A teaching CRNA is involved in two concurrent cases with student nurse anesthetists.
Case # Actual Time Description CRNA May Report
Case 1 9–11 a.m. The teaching CRNA is present in Case 1 from 9–9:30 a.m. and from 10:15–10:30 a.m.
45 minutes of Anesthesia time (3 time units)
The teaching CRNA is present in Case 2 from 9:45–10:14 a.m. and from 10:31–11:30 a.m.
88 minutes of Anesthesia time (5.9 time units
Change Request (CR) 6706 provides that the payment policy for the teaching CRNA in the single student nurse anesthetist case remains unchanged for services furnished on or after January 1, 2010; however, when involved with two concurrent cases with student nurse anesthetists (on or after this date), he can be paid at the regular fee schedule rate for each case.
To bill the base units for each of the two cases, the teaching CRNA must be present with the student during the pre- and post-anesthesia care for each case.
In addition, while he can decide how to allocate time to optimize patient care in the two cases based on the complexity of the anesthesia case, the experience and skills of the student nurse anesthetist, the patient’s health status and other factors, the CRNA must continue to devote all of his time to the two concurrent student nurse anesthetist cases and not be involved in other anesthesia cases. The teaching CRNA may bill usual anesthesia time for each anesthesia case.
For services furnished on or after January 1, 2010, the teaching CRNA should report these cases with the QZ modifier as described above. The teaching CRNA’s medical record documentation in these cases must be sufficient to support the payment of the fee and be available for review upon request. Additionally, be aware that no payment is made under Part B for the service provided by a student nurse anesthetist