Anesthesia Coding Alert

Be sure your physicians meet all 7 guidelines.

The first guideline for medical direction is that the anesthesiologist must be directing four or fewer concurrent cases. But before you automatically 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), be sure he also meets CMS' seven rules for medical direction:

1. Perform preoperative examination and evaluation.

2. Prescribe the anesthesia plan.

3. Personally participate in the most demanding procedures of the anesthesia plan, including induction and emergence.

4. Ensure that any procedures in the anesthesia plan are performed by a qualified anesthetist.

5. Monitor  and document  the course of the anesthesia administration at frequent intervals.

6. Be physically present and available for immediate diagnosis and treatment of emergencies.

7. Provide the post-anesthesia care indicated.

If the anesthesiologist fails to meet any of these criteria (or if the case load climbs to five concurrent cases), you must report the cases as medically supervised by appending modifier AD (Medical supervision by a physician: more than four concurrent anesthesia procedures) instead of medically directed. Some states allow a CRNA to report modifier QZ (CRNA service: without medical direction by a physician). Know your practice and local guidelines before submitting your final claim.