Saturday, March 16, 2013

Anesthesia CPT modifiers list

.Anesthesia Modifiers

.Physical Status (PS)

P1  A normal healthy patient 
P2  A patient with mild systemic disease 
P3  A patient with severe systemic disease 
P4  A patient with severe systemic disease that is a constant threat to life 
P5  A moribund patient who is not expected to survive without surgery 
P6  A declared brain-dead patient whose organs are removed for donor  purposes 


Anesthesiologist Modifiers

* AA – Anesthesia services performed personally by an anesthesiologist (includes reimbursement of an employed CRNA)

* AD – Medical supervision by a physician. More than four concurrent anesthesia procedures.

* QK – Medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals

* QY – Medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist


CRNA Modifiers

* QX – CRNA service with medical direction by a physician

 QZ – CRNA service without medical direction by a physician


Monitored Anesthesia Care Modifiers

BlueCross may reimburse for modifiers QS, G8 and G9 if a physician personally performs the procedure (modifier AA) and if the procedure meets medical necessity criteria. BlueCross will not reimburse modifiers QK, QX, QY and QZ for supervision of monitored anesthesia care (MAC). BlueCross will not reimburse CRNAs for MAC.

* QS – Monitored anesthesia care service (must appear in the second modifier field)

* G8 – Monitored anesthesia care (MAC) for a deep complex, complicated or markedly invasive surgical procedure (must appear in the second modifier field)

* G9 – Monitored anesthesia care for a patient who has a history of severe cardiopulmonary condition (must appear in the second modifier field)


Anesthesia Risk Factors

Anesthesiologists or nurse anesthetists can file three modifiers indicating they have added time limits when the physical status of the patient presented a serious health risk. They must place these modifiers in the second modifier field of the claim form.

BlueCross will only pay risk factors if the physician (modifier AA on the primary anesthesia code) administers the anesthesia personally. There will be no separate  reimbursement for risk factors for CRNAs or anesthesiologist supervision of CRNAs, even if they report it separately.

Risk Modifiers

P-3 Add one time unit when a patient has a severe systemic disease, such as uncontrolled diabetes or hypertension requiring medication.

P-4 Add two time units when a patient has a severe systemic disease that is a constant threat to life, such as severe respiratory or cardiac disease.

P-5 Add three time units when the patient is not expected to survive for 24 hours with or without the operation, such as multiple severe trauma or severe head injury


Other Anesthesia Modifiers



Under certain circumstances, medical services and procedures may need to be further modified. Modifiers commonly used in anesthesia are :

22 Unusual Procedural Services: When the service(s) provided is greater than that usually required for the used rather than modifier 59. Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used.

AA Anesthesia Services performed personally by the anesthesiologist: Report modifier AA when the anesthesia services are personally performed by an anesthesiologist. Claims submitted with modifier AA are reimbursed at 100 percent.

AD Medical Supervision by a Physician; More Than Four Concurrent Anesthesia Procedures: Report modifier AD when the anesthesiologist supervises more than four
concurrent anesthesia procedures. Claims submitted with modifier AD are reimbursed as described in the preceding section.

G8 Monitored Anesthesia Care (MAC) for Deep, Complex, Complicated or Markedly Invasive Surgical Procedures: Report modifier G8 when monitored anesthesia care is requied for deep, complex, complicated or markedly invasive surgical procedures.

G9 Monitored Anesthesia Care for Patient Who Has a History of Severe Cardiopulmonary Condition: Report modifier G9 when monitored anesthesia care is required for a patient who has a history of severe cardiopulmonary condition.

NT No Time (State Specific Modifier): If the surgeon or attending physician administers a local or regional block for anesthesia during a procedure, the bill should so
indicate with the use of modifier NT for “no time.”

QK Medical Direction of Two, Three, or Four Concurrent Anesthesia Procedures Involving Qualified Individuals: Report modifier QK when the anesthesiologist supervises two, three, or four concurrent anesthesia procedures. Claims submitted with modifier QK are reimbursed at 50 percent.

QS Monitored Anesthesia Care Service: The QS modifier is for informational purposes.

QX CRNA Service with Medical Direction by a Physician: Regional or general anesthesia provided by the CRNA with medical direction by a physician may be reported by adding modifier QX. Claims submitted with modifier QX are reimbursed at 50 percent.

QY Medical Supervision by Physician of One CRNA: Report modifier QY when the anesthesiologist supervises one CRNA. Claims submitted with modifier QY are reimbursed at 50 percent. QZ CRNA Service without Medical Direction by a Physician: Regional or general anesthesia provided by the CRNA without medical direction by a physician may be reported by adding modifier QZ. Claims submitted with modifier QZ are reimbursed at 100 percent

 In anesthesia every anesthesia procedure billed to Medicare must include one of the following anesthesia HCPCS modifiers:

• AA: Anesthesia services performed personally by anesthesiologist or when an anesthetist assists a physician in the care of a single patient.

• QY: Medical direction of one Qualified Nonphysician

• QK: Medical direction of two, three or four concurrent anesthesia procedures involving qualifi ed individuals.

• AD: Medical supervision by a physician: more than four concurrent anesthesia procedures.

• QX: Qualified Nonphysician Anesthetist service: with medical direction by a physician.

• QZ: Qualified Nonphysician Anesthetist service: without medical direction by a physician. Note: For examples of correct and incorrect usage of each modifier, refer to our “Modifier Lookup Tool” on the Palmetto GBA website under the “Self-Service Tools” on the home page.

In addition to the above modifiers, there are others modifiers that may be used to identify specific situations in addition to the above required modifiers. Additional HCPCS Modifiers Anesthesiologist

Note: Do not use these HCPCS modifiers if the provider of service is a Qualified Nonphysician Anesthetist or AA

• AA : Anesthesia service personally performed by the anesthesiologist.

• QY: Medical direction of one Qualified Nonphysician Anesthetist by an anesthesiologist.

• QK: Medical direction of two, three or four concurrent anesthesia procedures.

• AD: Supervision, more than four procedures. Qualifi ed Nonphysician Anesthetist

Note: Do not use these HCPCS modifiers if the provider of service is an Anesthesiologist

• QX: Anesthesia, Qualified Nonphysician Anesthetist medically directed.

• QZ: Anesthesia, Qualified Nonphysician Anesthetist not medically directed. Monitored Anesthesia Care (MAC)

• QS: Monitored Anesthesia Care services (can billed by a Qualified Nonphysician Anesthetist, AA or physician).

Approximately 4,000 surgical , medical, and radiology procedures are presented by 268 anesthesia codes.

ANESTHESIA CODE RANGES


00100 - 00222  Head  00300 - 00352  Neck
00400 - 00474  Thorax  00500 - 00580  Intrathoracic
00600 - 00670  Spine and Spinal Cord  00700 - 00797  Upper Abdomen
00800 - 00882  Lower Abdomen  00902 - 00952  Perineum
01112 - 01190  Pelvis (Except Hip)  01200 - 01274  Upper Leg (except knee)
01320 - 01444  Knee and Popliteal Area  01462 - 01522  Lower Leg (below Knee)
01610 - 01682  Shoulder and Axilla  01710 - 01782  Upper Arm and Elbow
01810 - 01860  Forearm, Wrist and Hand  01905 - 01933  Radiological Procedures
01951 - 01953  Burns, Excisions or  01960 - 01969  Obstetrics
Debridement  01990 - 01999  Other Procedures

•    Anesthesia services include: .preoperative and postoperative visits, .anesthesia care during the procedure, .administration of fluids and/or blood, and

.    the usual monitoring services (e.g., ECG, temperature, blood pressure, oximetry, capnography, and mass spectrometry).

•    Unusual forms of monitoring (e.g., intra-arterial, central venous, and Swan-Ganz) are not included. Bill these specialized services separately.


Anesthesia Modifiers Description Adjustment Rate

Modifier AA - Administered by anesthesiologist - 100% of Fee Schedule Allowance/Contracted Rate

Modifier AD - Medical supervision more then four concurrent anesthesia procedures - 50% of Fee Schedule Allowance/Contracted Rate

Modifier QK - Medical direction of two three or four concurrent anesthesia procedures involving qualified individuals - 50% of Fee Schedule Allowance/Contracted Rate

Modifier QS - Monitored anesthesia service - 100% of Fee Schedule Allowance/Contracted Rate

Modifier QX - Administered by CRNA with medical direction - 50% of Fee Schedule Allowance/Contracted Rate

Modifier QY - Medical direction of CRNA by anesthesiologist - 50% of Fee Schedule Allowance/Contracted Rate

Modifier QZ - Administered by CRNA without medical direction - 100% of Fee Schedule Allowance/Contracted Rate

2 comments:

  1. Hi
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  2. I am being billed for procedure code 01967. It is listed twice with two separate physician's. I had only one epidural placed correctly, and a vaginal birth. When I called to question the bill, I was told that one was for the person to administer the epidural and the other was for the "guide" to help them. I had one anesthesiologist in the room, and then my nurse who didn't do anything other than to re-iterate what the anesthesiologist said about what my posture should be during the placement of the needle. I do not think I am being billed correctly. Can you help advise?

    ReplyDelete

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