Anesthesia Coding Alert

Plus: Count cases to ensure it’s not medical supervision instead.

“Medical direction" describes when an anesthesiologist oversees two, three, or four concurrent anesthesia procedures involving other qualified individuals. You append modifier QY (Medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist) or QK (Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals) to the anesthesiologist’s claim to indicate medical direction.

Seven criteria must be met before you can report an anesthesiologist’s claim as medical direction. They are:

1. Perform a pre-anesthesia evaluation.

2. Prescribe an anesthesia plan.

3. Personally participate in the key components of the case, including procedures as well as induction and emergence (induction and emergency apply to general anesthesia, not regional or monitored anesthesia care).

4. Ensure that all additional procedures (such as line placements) are performed by only the anesthesiologist or qualified anesthetist.

5. Monitor the course of anesthesia administration at regular intervals (a good general rule of thumb is for cases exceeding one hour, at least one interval check per hour or more if the case requires additional monitoring).

6. Be physically present and/or available to address any emergencies that might arise.

7. Provide post-anesthesia care.

Also remember: Concurrent anesthesia procedures are those that overlap — even if only by one minute. The anesthesiologist shifts from medical direction to medical supervision once she oversees more than four concurrent anesthesia procedures. In some states, medical supervision applies if the anesthesiologist doesn’t meet all seven criteria for medical direction.

Extra tip: Check your Medicare Administrative Contractor website for anesthesia Frequently Asked Questions (FAQS) which may address whether medical direction becomes medical supervision if one of the “seven steps” is not performed or not documented.