Everything You Need To Know About Anesthesia Modifiers

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Everything You Need To Know About
Anesthesia Modifiers
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Everything You Need To Know About Anesthesia
Modifiers
To accurately get reimbursed for anesthesia
services, one should know billing rules and
guidelines that are specific to anesthesia care.
Modifiers play a crucial role in anesthesia
billing due to a variety of scenarios including
an anesthesiologist, nurse anesthetist, or
anesthesiologist assistant. The formula used to
determine payment for anesthesia services is
unique to anesthesia billing only. In this
article, we explained anesthesia modifiers, their
descriptions, and when and how to use
them. Defining Concurrent Cases As per the
Medicare claims processing manual, A physician
who is concurrently furnishing services that meet
the requirement for payment at the medically
directed rate cannot ordinarily be involved in
furnishing additional services to other patients.
However, addressing an emergency of short
duration in the immediate area, administering an
epidural or caudal anesthetic to ease labor pain,
periodic (rather than continuous) monitoring of
an obstetrical patient, receiving patients
entering the operating suite for the next
surgery, checking or discharging the patient in
the recovery room, or handling scheduling
matters, do not substantially diminish the scope
of control exercised by the physician and do not
constitute a separate service for the purpose of
determining whether the requirements for payment
at the medically directed rate are met. Note
that when counting concurrent cases, all cases
matter. There cannot be even one minute of
overlap among any of the cases. Concurrency
counts are not limited only to those cases that
involve Medicare beneficiaries.
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Everything You Need To Know About Anesthesia
Modifiers
There are limits on the activities an
anesthesiologist may perform while providing
medical direction. These are interruptible and
allow the anesthesiologist to maintain the
necessary level of involvement in the medically
directed cases to be available for immediate
diagnosis and treatment of emergencies. Anesthesi
a Modifiers Modifier AA Anesthesia Services
Performed Personally by the Anesthesiologist Repor
t anesthesia services personally performed by the
anesthesiologist with modifier AA. Modifier AA is
used when a physician anesthesiologist performs
the entire anesthesia service. Or he is
continuously involved in a single case with a
student nurse anesthetist. Or he is involved in
training residents in up to two concurrent cases
meeting teaching physician requirements (while
billing uses both modifier AA and modifier GC).
These services have been performed by a resident
under the direction of a teaching physician.
Modifier AA may also apply in extraordinary
circumstances in which the services of two
anesthesiologists, or an anesthesiologist and a
nurse anesthetist or anesthesiologist assistant
are medically necessary. Medicare (and most
commercial payers) pays 100 percent of the
allowed amount to the physician anesthesiologist
when reporting a claim with the AA
modifier. Modifier AA may only be reported by
the teaching physician if the resident performs
the entire case. If the resident performs a
specific portion of the case (e.g. intubation,
induction, placement of epidural, nerve block,
etc.)
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Everything You Need To Know About Anesthesia
Modifiers
and then hands off the case to a Certified
Registered Nurse Anesthetist (CRNA) or other
provider who completes the case, the service was
no longer personally performed by the resident
and teaching physician. Instead, the lower
anesthesia payment modifier should be
selected. Modifier AD Medical Supervision by a
Physician for More than 4 Concurrent Anesthesia
Procedures Modifier AD is used when medical
supervision is done by the anesthesiologist who
is involved in more than four concurrent
anesthesia services, or he performs other
services while directing anesthesia care. Payment
to the anesthesiologist will be based on three
base units per procedure when the
anesthesiologist is involved in furnishing more
than four procedures concurrently or is
performing other services while directing the
concurrent procedure. An additional time unit can
be recognized if the physician can document he
was present at induction. Modifier QK Medical
Direction of two (2), three (3), or four (4)
Concurrent Anesthesia Procedures involving
Qualified Individuals When two (2), three (3), or
four (4) concurrent anesthesia procedures are
medically directed, report with modifier QK.
Services submitted with modifier QK will be
reimbursed at 50 percent of the applicable fee
schedule rate. Services by the teaching physician
must be submitted with modifier QK when directing
three, or four residents, student nurse
anesthetists, or CRNAs concurrently.
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Everything You Need To Know About Anesthesia
Modifiers

• Modifier QY Medical Direction of one (1)
  Qualified Non-Physician Anesthetist by an
  Anesthesiologist
• As the description suggests, modifier QY is used
  when a medical direction of one (1) qualified
  non-physician anesthetist is done by an
  anesthesiologist. In such cases, the Centers for
  Medicare Medicaid Services (CMS) mentioned a
  few guidelines for medically directing
  anesthesiologists. Medicare and most commercial
  payers follow these guidelines. As per CMS
  guidelines, a medically directing
  anesthesiologist must
• Perform a pre-anesthetic examination and
  evaluation
• Prescribe the anesthesia plan
• Personally participate in the most demanding
  procedures in the anesthesia plan, including, if
  applicable, induction and emergence
• Ensure that any procedures in the anesthesia plan
  that he/she does not perform are performed by a
  qualified individual
• Monitor the course of anesthesia at frequent
  intervals
• Remain physically present and available for
  immediate diagnosis and treatment of emergencies
• Provide indicated post-anesthesia care.

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Everything You Need To Know About Anesthesia
Modifiers
Modifier QX Qualified Non-Physician Anesthetist
Service (with Medical Direction by a
Physician) Modifier QX is used by a nurse
anesthetist or anesthesiologist assistant when
medically directed by a physician
anesthesiologist. In such a case, as discussed
above, a physician anesthesiologist would submit
a corresponding claim for medical direction,
either with modifier QK or modifier QY.Payment
for this service is split between the two
anesthesia professionals with 50 percent of the
allowed amount paid to the anesthesiologist and
50 percent to the nurse anesthetist or
anesthesiologist assistant. To cross-check check
billing accuracy of anesthesia services, a claim
submitted with the modifier QX should match a
claim submitted with the modifier AD. Modifier
QZ Certified Registered Nurse Anesthetist (CRNA)
Service (without Medical Direction by a
Physician) This modifier is specific to certified
registered nurse anesthetists and should not be
reported by anesthesiologist assistants. In this
scenario, a nurse anesthetist provides care under
the supervision of or via a collaborative
arrangement with the surgeon of other mode as
permitted by state law medical direction by a
physician anesthesiologist is not present. The
nurse anesthetist receives 100 percent of the
allowed amount for cases reported with the QZ
modifier. Medisys Data Solutions is a leading
medical billing company providing complete
billing and coding services for various medical
billing specialties. We hope that our article on
anesthesia modifiers will guide you in accurately
billing for anesthesia services. If you are
seeking assistance in anesthesiology billing and
coding for your practice, contact us at
info_at_medisysdata.com / 888-720-8884
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