Anesthesia Coding Alert

Hint: They might give new coders a clearer understanding.

The Relative Value Guide (RVG) from the American Society of Anesthesiologists has different wording for some of the modifiers representing anesthesia service providers, says Kelly D. Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPMA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fl. Here are their more explanatory versions of modifiers QX, QY, and QZ:

• QX (CRNA service: with medical direction by a physician (this modifier also includes anesthesia assistants and is also identified as “Qualified nonphysician anesthetist service; With medical direction by a physician”))
• QY (Medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist (this modifier also includes anesthesia assistance and is also identified as either “Medical direction of one qualified non physician anesthetist by an anesthesiologist” or “Medical direction of one CRNA/AA by an anesthesiologist”)
• QZ (CRNA service: without medical direction by a physician. (Anesthesia assistants do not report services using this modifier as medical direction by an anesthesiologist is required)).

Some payers also have simplified versions of the descriptors. These, for example, are from Novitas:

• AA (Anesthesia services personally performed by the anesthesiologist)
• AD (Supervision, more than four procedures)
• QK (Medical direction of two, three, or four concurrent anesthesia procedures)
• QX (Qualified non-physician anesthetist with medical direction by a physician)
• QY (Medical direction of one CRNA/AA by an anesthesiologist)
• QZ (Certified Registered Nurse Anesthetist (CRNA) without medical direction by a physician).

Bottom line: The modifiers represent the same professional services in each of these three lists, but the altered descriptors might make it easier for some coders to understand the distinctions.