Anesthesia Coding Alert

Modifiers are an integral part of coding for anesthesia practices. Some, such as physical status modifiers, should be filed with each procedure as appropriate. Other modifiers that further explain the situation are used often as well. These modifiers are divided into three groups:

Level I, or CPT, modifiers are two numeric digits, such as -22, (unusual procedural services).

Level II national modifiers are two alphabetic digits (AA-VP). They are recognized by carriers nationally and are updated each year by the Health Care Financing Administration (HCFA).

Level III, or local, modifiers are assigned by individual Medicare carriers and are shared with physicians and other providers through carrier newsletters. Individual carriers may change, add or delete these local modifiers as needed.

The Level I modifiers most often used for anesthesia were discussed in the article Correct Usage of Modifiers Can Optimize Reimbursement, page 3 in the January 2000 issue of Anesthesia Coding Alert. In this issue we discuss the Level II modifiers most appropriate to anesthesia as found in HCPCS 2000.

Deleted Medicare Modifiers

Several modifiers that applied to anesthesia have been deleted from HCPCS 2000. Walter Pritchard, administrator at Anesthesia Service of Eugene, a 29-physician anesthesia group in Eugene, Ore., thinks this shows HCFAs attempts to keep the list aligned with the modifiers most practices use. Many of these deleted modifiers werent really used anyway, he says. They have not been used for some time, and this just makes it official.

Several of the deleted codes related to cases that were medically directed. Pritchard and Barbara Bastin, office manager of the physician group Greenwich Medical Anesthesia and University Pain Center in New York, N.Y., recommend using these codes in their place:

-AB (medical direction of own employee[s] by anesthesiologist [not more than four employees.]) This modifier was used only for state Medicaid cases, not for Medicare. We never used this modifier anyway, Bastin says. We havent used this in years, Pritchard adds. We use modifiers -QK or -QY instead. (see below)

-AC (medical direction of other than own employees by an anesthesiologist [not more than four individuals]). The physicians in Pritchards group only direct their own employees, so he says they have never used this modifier either.

-AE (direction of residents in furnishing not more than two concurrent anesthesia servicesattending physician relationship met). Neither Bastin nor Pritchard had been using this modifier. Empire Blue Cross/Blue Shield in New York doesnt accept this modifier, says Bastin. Weve always used -QK instead.

-AF (anesthesia complicated by total body hypothermia). Bastins group used this modifier only for state Medicaid claims, not for Medicare cases. She says New York state still accepts it; other states may be the [...]