Wouldn’t it be great to be able to be in two or more places at the same time? And get paid for it? While physically impossible to be in multiple surgeries at once, anesthesiologists can supervise up to four Certified Registered Nurse Anesthesiologists (CRNAs) in concurrent surgeries. Anesthesia practices can ensure that they receive the compensation they deserve for both physicians and CRNAs in concurrent surgeries with accurate minute-by-minute tracking, proper use of CMS modifiers and intimate knowledge of insurance carriers’ requirements.
Anesthesia procedures are personally performed by either an anesthesiologist or CRNA. Medical direction of anesthesia services occurs when an anesthesiologist is involved in two, three or four concurrent anesthesia procedures. Note that an anesthesiologist cannot be the sole anesthesia provider in one surgery and provide medical direction to others.
Make Every Minute Count
Exact time tracking is a key factor to successful anesthesia concurrency reimbursement. Coders and billers should rely on a combination of the following tracking tools:
Provider time sheets: Indicating the exact time physicians and CRNAs enter and leave a surgical suite
Anesthesia charts: Electronic or hand-written notes indicating all the equipment and drugs used during the procedure
Electronic medical records (EMRs): Constantly monitor and record patients’ vital signs while in surgery, giving clues as to where anesthesiologists are
Make Use of Modifiers
Accurate documentation is supported by the proper use of CMS modifiers in order to achieve timely and maximum reimbursement. If concurrency occurs, CMS modifiers like QY (supervising 1 CRNA) and QK (supervising more than 1 CRNA) are required.
Coding can become quite complicated, depending on different scenarios. For example, there are “relief claims” when a supervising physician takes a break or goes to lunch. The minute that the first physician leaves must be documented (e.g., 11:38 am) and the replacement physician must be documented to arrive the following minute (e.g., 11:39 am) to show the flow of concurrency. The times cannot overlap and there cannot be a gap. If the CRNA leaves and the physician is now in the surgery alone, an entirely new claim must be submitted.
Most modern and reputable coding and billing companies use software programs to identify errors prior to claims submission. Once all charges and times are entered, concurrency reports are run to highlight overlapping times, invalid times, inconsistent or suspect coding, add modifiers, etc. (Note: A physician really can’t be in two places at one time!)
Know and Follow the Rules
Modifier 76 (same physician) and modifier 77 (another physician) are used to report a repeat procedure or service on the same day and are appended to the procedure to report. The documentation should indicate that a procedure or service was repeated subsequent to the original procedure or service.
Unique insurance carrier requirements further complicate the claims process for anesthesiology practices. Some require separate claim forms for physicians and CRNAs, while others require them to be on the same claim form. It is critical for anesthesiology practices and their coding and billing partners to know and follow the specific rules to ensure that both the physician line and the CRNA lines are being paid correctly.
Conclusion
Anesthesia concurrency coding and billing can be complicated; when done properly, it can yield excellent results for hard-working anesthesia practices.
