# CRNA anesthesia modifiers for ASC



## WROGERS (Feb 27, 2014)

Please help!!!

I do coding for an ASC who employs CRNA's. The ASC is in the state of NY. Which requires all CRNA to be supervised. NY does states the supervision has to be an MD (does not state what type of MD). The CRNA's are supervised by the GI doctors performing the endoscopy. They are not directed by an Anesthesiologist.

I need clarification that appending the modifier "QZ" to the CRNA claim is appropriate for billing purposes since it is a "GI" supervising not an Anesthesiologist.  The GI doctor is taking responsibility for the CRNA.

If there are any Anesthesia GURU's to help, please do so!


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## hgolfos (Feb 27, 2014)

I would say yes, QZ.  If you bill a QX claim the payer will look for a QY or QK claim to be submitted as well, but there won't be one because the GI doctor can't submit a claim for both anesthesia and the procedure.

I don't know anything about the NY rules requiring CRNA's to be supervised though.  That's one I've not heard before.


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## WROGERS (Feb 27, 2014)

Thanks.  I believe QZ is correct as well.  However, clarification from other coders is always nice.


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## jaoconne (Jul 25, 2017)

*Hope this helps....*

I am in agreement with the others, I would go back and question the documentation first, because most likely, a GI without a QZ modifier is only going to get denied, and you are going to be asking for documentation anyway. There IS a possibility that QY is billable, as a MDA can stand in for the anesthesiogist, if he/she is truly only there to ONLY supervise, due to comorbidities, etc...., but it's usually a HUGE red flag with payers, especially the bigger ones. AND, with QY, your MDA is not going to get paid for the supervision. This is why the QZ is mostly used, to indicate it is medically necessary for both to be there. 

Also, make sure your Q modifiers are on there. You'd be surprised how many claims get denied just from not having a P2 at least, if this is pertinent. And how many I have fixed for something so simple, lol!


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