Anesthesia billing

[deleted880510]

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I am anesthesia and pain boarded. If I am performing a pain procedure under sedation, can I bill for supervising the CRNA as well? Anyone know the rules behind this? Thanks

 

[gdub25]

Your CRNA can bill for prone MAC just as they could for any other type of position doing a procedure. You being an anesthesiologist has no bearing on their ability to bill. You cannot however bill is the surgeon and has the anesthesia provider at the same time. So for example, if a general surgeon is doing a hernia repair and the cRNA is doing the anesthesia, the surgeon bills for his professional services and the cRNA bills for their’s. Just doing injections is no different. Higher the cRNA as an employee and pay them a salary and you will have their billing rates, you collect the money and pay them their salary and keep the leftover. So for example, if a general surgeon is doing a hernia repair and the cRNA is doing the anesthesia, the surgeon bills for his professional services and the cRNA bills for their’s. Us doing injections is no different. Hire the cRNA as an employee and pay them a salary and you will have their billing rates, you collect the money and pay them their salary and keep the left over

 

[Orin]

Yeah, the magic here then is to have your partner anesthesiologist supervising the CRNA while seeing clinic patients?

 

[BobBarker]

Have crna bill qz so there is no funny business. Not worth fudging on something like that when qz will be correct and truthful.

 

[drpainfree]

Yeah, the magic here then is to have your partner anesthesiologist supervising the CRNA while seeing clinic patients?

OP was saying sedation. Was he referring to office-based sedation or a MAC in ASC?

 

[deleted880510]

OP was saying sedation. Was he referring to office-based sedation or a MAC in ASC?

Thanks for the info. It is office based sedation, but we use a fair amount of propofol.

 

[BobBarker]

There is no role ever for propofol in your office for “sedation”.

 

[deleted880510]

There is no role ever for propofol in your office for “sedation”.

we do rhizos and stim trials in the office, so will mainly use it for that

 

[buddababa]

we do rhizos and stim trials in the office, so will mainly use it for that

A little versed, maybe some fentanyl can be sufficient for both. I commonly do both trials and rhizo without sedation. Maybe valium

 

[painfree23]

we do rhizos and stim trials in the office, so will mainly use it for that

I do all that without sedation. Just wait an extra min for the local to work.

 

[gdub25]

I agree, propofol has no role and we do all of our injections, stem trials, and RFA without any sedation with exception of occasional Valium.

This is the second time in a week that I’m throwing this offer out there for folks but you’re welcome to come visit our practice anytime and see how we do things. Not saying that we have it all figured out by any means but if we can help others be more efficient and possibly safer then we are happy to share what we’ve learned over the years.

 

[BobBarker]

The propofol makes them move more until you get them to GA territory.

 

[Wkrdoc]

We use small amounts of propofol without any issues. Patient satisfaction is way better with it. Before done a lot with and without

 

[painfree23]

We use small amounts of propofol without any issues. Patient satisfaction is way better with it. Before done a lot with and without

One squirt before each Mbnb needle insertion?

 

[painfree23]

The propofol makes them move more until you get them to GA territory.

If u don’t get them to GA territory, what$ the point$$$?

 

[drusso]

Does anyone think its interesting that we have no consensus for sedation for pain procedures? How come some people are using propofol in the office while others are just local and maybe a little oral diazepam?

 

[SSdoc33]

Does anyone think its interesting that we have no consensus for sedation for pain procedures? How come some people are using propofol in the office while others are just local and maybe a little oral diazepam?

and still others use nothing.....

 

[Ferrismonk]

C'mon people, you should know better. The drug used isn't the anesthesia. I can do GA with fentanyl/versed and I can do anxiolysis with propofol. Propofol does not equal general anesthesia.

Regarding the CRNA billing, you have 4 options.

1. They bill the QZ modifier (100% on them, you get nothing).
2. They are an employee (even a 1099 locum situation is okay) hired by your company (maybe your separate anesthesia company?), and you pay them a flat fee (per hour maybe) but bill for anesthesia services yourself. You keep what your company collects. Still billed with QZ.
3. Bill as sedation directed by you (99151, 99152, 99153, 99155, 99156, 99157 ), aka no CRNA fee. Basically your CRNA is asking like a RN.
4. I know some people try to bill the partner supervising the CRNA while seeing patients next door, but I believe is not considered legal and I seem to recall people being busted for this.

All that being said, in states where a CRNA must be supervised, I believe the surgeon can legally supervise (regardless of anesthesia training), they just can't bill for the supervision.

 

[Ferrismonk]

Does anyone think its interesting that we have no consensus for sedation for pain procedures? How come some people are using propofol in the office while others are just local and maybe a little oral diazepam?

I think it's interesting we can't even get consensus on how to do the freaking procedures.

 

[deleted880510]

Thank you for the information @Ferrismonk , much appreciated. Does anyone know if there is a difference in reimbursement between QZ and QX/AA (physician directed), or is it a flat fee paid out regardless of who performed the services?

 

[Ferrismonk]

Thank you for the information @Ferrismonk , much appreciated. Does anyone know if there is a difference in reimbursement between QZ and QX/AA (physician directed), or is it a flat fee paid out regardless of who performed the services?

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