Wednesday, May 25, 2016

Anesthesia Modifiers - Primary and Secondary, Tertiary



Modifiers are two-digit indicators that are used with a procedure code to add specific meaning to a service provided. Every anesthesia administrative code billed to Florida Blue must include a modifier. More than one modifier can be submitted per detail line; however, the Florida Blue claims system will adjudicate the claim based only on the first modifier submitted.

When an anesthesiologist medically directs the services of a CRNA or AA, it is recommended that two separate claims should be submitted using the same CPT code and the same amount of time on each claim with the appropriate modifiers.

In unusual circumstances, such as complicated trauma case, it may be necessary for both the CRNA and the anesthesiologist to be involved completely and fully in a single case. Both the CRNA and the anesthesiologist must submit documentation.


Primary Anesthesia Modifiers

Modifier     Description    Modifier Allowance Adjustment


AA   Anesthesia services performed personally by the anesthesiologist  100%
AD  Modifier AD (medical direction of five or more concurrent anesthesia procedures by an anesthesiologist) is not recognized by Florida Blue for reimbursement except for Medicare Advantage products.    0%
QK    Medical direction (by anesthesiologist) of two, three or four concurrent procedures by qualified personnel  50%
QY Medical direction of one CRNA/AA by an anesthesiologist 50%
QX CRNA/AA service with medical direction by an anesthesiologist   50%
QZ CRNA service without medical direction by an anesthesiologist   100%

Secondary and Tertiary Anesthesia Modifiers

Modifier Description

QS MAC service. Only one QS service per day will be allowed.
23 Unusual Anesthesia. Occasionally a procedure that usually requires either no anesthesia or local anesthesia, because of unusual circumstances, must be done under general anesthesia. This circumstance may be reported by adding the modifier “23” to the procedure code of the basic service.
53  Discontinued Procedure. Due to extenuating circumstances or those that threaten the well-being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. This circumstance may be reported by adding the modifier “53” to the code reported for the discontinued procedure.
59 Distinct Procedural Service. Under certain circumstances procedures representing a different session or patient encounter, different site or organ system, separate lesions or separate injury, not ordinarily encountered or performed on the same day by the same physician. Services with modifier 59 could be subject to Florida Blue review of medical records.

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