Sunday, August 28, 2016

Modifier question on anethesia claims?

Q. What defines medical direction?

For each anesthesia procedure, the anesthesiologist must perform all of the following seven services and they must be recorded in the anesthesia record:
1. Perform a pre-anesthetic examination and evaluation;
2. Prescribe the anesthesia plan;
3. Personally participate in the most demanding procedures of the anesthsia plan including, if
applicable, induction and emergence;
4. Ensure that any procedure in the anesthesia plan that he or she does not perform are performed
by a qualified anesthetist;
5. Monitor the course of anesthesia administration at frequent intervals;
6. Remain physically present and available for immediate diagnosis and treatment of
emergencies; and
7. Provide all the indicated post-anesthesia care.

Q. What will happen if the modifiers are not on the claims?
These edits will be specific to the provider’s specialty, and claims that do not contain the appropriate modifiers or have inappropriate modifier combinations will be returned to the provider for correction.

Q. What are the specialty and modifier requirements?

• Anesthesiologist:
AA - Anesthesia services performed personally by the anesthesiologist
AD - Medical supervision of five or more concurrent anesthesia procedures by an anesthesiologist
QK - Medical direction (by anesthesiologist) of two, three or four concurrent procedures
QY - Medical direction of one CRNA/AA by an anesthesiologist
• CRNA/AA:
QX - CRNA/AA service with medical direction by an anesthesiologist
• CRNA:
QZ - CRNA service without medical direction by an anesthesiologist

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