# modifier AA



## Nancy Klein (Jul 20, 2011)

Hello,
I'm looking for written proof (CMS) stating that an Anesthesiologist must remain present in the OR for the duration of a case when billing with modifier AA.  Is there any policy that states the definition of Modifier AA, other than "Anesthesia services performed personally by anesthesiologist"?  The cases in question involve Monitored Anesthesia Care.  The doctor would like to leave the room and have an RN (not a CRNA) monitor the case.  I think the answer is no you can't do that but would like written proof from Medicare.  
Thanks in advance.


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## dwaldman (Jul 20, 2011)

I think you would be able to find some helpful information regarding this if you could check your state guidelines.

Below is from the claims processing manual from Medicare which I saw gives examples of payment for personally performed. I don't see example that describes the situation that you are presenting. 

https://www.cms.gov/manuals/downloads/clm104c12.pdf
Page 120


B. Payment at Personally Performed Rate
The Part B Contractor must determine the fee schedule payment, recognizing the base unit for the anesthesia code and one time unit per 15 minutes of anesthesia time if:
• The physician personally performed the entire anesthesia service alone;
• The physician is involved with one anesthesia case with a resident, the physician is a teaching physician as defined in Â§100, and the service is furnished on or after January 1, 1996;
• The physician is involved in the training of physician residents in a single anesthesia case, two concurrent anesthesia cases involving residents or a single anesthesia case involving a resident that is concurrent to another case paid under the medical direction rules. The physician meets the teaching physician criteria in Â§100.1.4 and the service is furnished on or after January 1, 2010;
• The physician is continuously involved in a single case involving a student nurse anesthetist;
• The physician is continuously involved in one anesthesia case involving a CRNA (or AA) and the service was furnished prior to January 1, 1998. If the physician is involved with a single case with a CRNA (or AA) and the service was furnished on or after January 1, 1998, carriers may pay the physician service and the CRNA (or AA) service in accordance with the medical direction payment policy; or
• The physician and the CRNA (or AA) are involved in one anesthesia case and the services of each are found to be medically necessary. Documentation must be submitted by both the CRNA and the physician to support payment of the full fee for each of the two providers. The physician reports the â€œAAâ€� modifier and the CRNA reports the â€œQZâ€� modifier for a nonmedically directed case.


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## dwaldman (Jul 21, 2011)

http://www.asahq.org/For-Healthcare-Professionals/Standards-Guidelines-and-Statements.aspx

If you click on some the articles within this link, there might some information this of use to you.


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## lalauria (Apr 15, 2014)

*Fluoro*

Hello....I have a MD  that performed 62311 & 77003-26 and also 20610(trochanter) under fluoro as well....indicating 77002-26 to be billed as well. Can 77003-26 & 77002-26 be billed same session or only one fluoro be billed? Carrier is Medicaid of NC


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