Medical Direction and Medical supervision difference

Billing for Medical Direction

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.


Medical Supervision

When the anesthesiologist does not fulfill all of the “medical direction” requirements, the concurrent anesthesia services are considered medical supervision services and are not considered medical direction services. In this instance, the claim should be submitted as a CRNA service with the “QZ” modifier.

Physical Status Modifiers-Physical status modifiers distinguish between various levels of complexity of the anesthesia service provided based on the patient’s condition, and are represented by the letter P followed by a single digit; Note: Physical status modifiers do not impact reimbursement rates.



Modifier       Description

P1                Normal healthy patient

P2             Patient with mild systemic disease

P3        Patient with severe systemic disease

P4            Patient with severe systemic disease that is a constant threat to life

P5         Moribund patient who is not expected to survive without the operation

P6        Declared brain-dead patient whose organs are being removed for donor purposes