QZ billing

[Dr. Rude]

Yes.
Because anesthesiology is a discipline of medicine, not nursing - so medical staff bylaws apply which means that all patients must have a physician, not a nurse be ultimately responsible for care.
That can mean different things at different places.
If it’s a crna only practice, the physician - most commonly the surgeon is responsible.

Actually anesthesiology is also a discipline of nursing. At least under the law.
Agree with the rest of your post.

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[Dr. Rude]

There are a lot of practices, particularly in rural environments, where there are a couple of anesthesiologists and a ton of CRNAs. Are these docs taking the liability for every CRNA? For example, I interviewed for a job where there were 14 ORs, including cardiac cases, and 2 physicians daily. I didn’t take the job (or really even consider it), so I’m a bit light on the details. I was told the docs helped get the hearts launched and were available to assist with other cases. Would these two docs be on the hook for the liability for every OR? I hate the idea of this, but patients in rural areas also need care, so I’m conflicted. This was in Kentucky.

Yes they are on the hook medico legally. But, rural areas in general are not very plaintiff friendly as far as medmal goes.

 

[neutro]

Actually anesthesiology is also a discipline of nursing. At least under the law.
Agree with the rest of your post.

Let me put it this way, anesthesiology as a discipline is hijacked by nurses (CRNA) in this country under the guise of “more affordable and accessible care”. Their lobby is far stronger and larger than ours.

The fact remains that it’s a medical specialty, not a nursing one - despite the fact that they practice it also. Bylaws, rules and regulations, language on malpractice policies reflect this.

These definitions are very important to understand so we can educate CRNAs esp. those who confuse practicing “independently” with practicing “independently of a physician”.

Even in opt out states, the surgeon/ proceduralist is ultimately liable. This is why you cannot have two midlevels perform a surgery plus anesthetic. The surgeon is ultimately responsible as the only physician in the room. A lot of this is dictated by facility bylaws.

Remember, WHO considers this a medical speciality. CRNA concept is an American one.

 

[lopsidedmike]

Hi all,

I couldn't find this anywhere on SDN but a Stanford lecturer said you could bill modifier AD (for medical supervision 3+1 units if present for induction) with QZ (for CRNA not medically directed for 100% of the allowable). So basically per case, you could get 100 percent of the bill for the CRNA and an additional 4 units for the supervising doc as long as you meet criteria for AD modifier.

Has anyone done this?

 

[BLADEMDA]

AD Modifier​

This modifier is frequently being used on claims. This modifier is reported on a claim when the Anesthesiologist Medically supervises more than 4 concurrent anesthesia procedures. The payment is made as (3 base units + time units) x 50% when the Anesthesiologist is not present at the time of induction. When the Anesthesiologist is present at the time of induction and when supporting documentation is submitted an additional unit is paid. The payment is as follows (3 Base + time units + 1 time unit for induction) x 50%.

 

[Dr. Rude]

​

AD Modifier​

This modifier is frequently being used on claims. This modifier is reported on a claim when the Anesthesiologist Medically supervises more than 4 concurrent anesthesia procedures. The payment is made as (3 base units + time units) x 50% when the Anesthesiologist is not present at the time of induction. When the Anesthesiologist is present at the time of induction and when supporting documentation is submitted an additional unit is paid. The payment is as follows (3 Base + time units + 1 time unit for induction) x 50%.

Also if supervising more than 4 rooms.

 

[jwk]

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AD Modifier​

This modifier is frequently being used on claims. This modifier is reported on a claim when the Anesthesiologist Medically supervises more than 4 concurrent anesthesia procedures. The payment is made as (3 base units + time units) x 50% when the Anesthesiologist is not present at the time of induction. When the Anesthesiologist is present at the time of induction and when supporting documentation is submitted an additional unit is paid. The payment is as follows (3 Base + time units + 1 time unit for induction) x 50%.

If I remember correctly, QZ and AD aren't billed together. The total charge can't exceed 100% of the allowable. With medical direction, it's 50:50. With medical supervision is where the 3 units +1 unit if present for induction comes in and the CRNA gets 50%. With QZ, the CRNA portion is billed at 100% and the physician side gets nothing. A lot of groups are doing this to avoid the hassles of documentation with medical direction, but it then understates the contribution of physicians to the case. The CRNAs like to claim any case billed QZ is a case done independently - that's simply not correct. And - some insurance companies are now only reimbursing QZ at 85%.