Anesthesia Coding Alert

There are three ways to bill for an anesthesiologists services: as personally performed, medically directed or medically supervised. Each requires a different modifier. The definitions in HCPCS Codes2000 are straightforward: modifier -AA (anesthesia services performed personally by anesthesiologist), modifier -AD (medical supervision by a physician, more than four concurrent anesthesia procedures), modifier -QK (medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals) and modifier -QY (medical direction of one certified registered nurse anesthetist). Coders need to work with the anesthesia providers to ensure that cases and especially the start and stop times associated with them are documented thoroughly to know which modifier to use to get the appropriate reimbursement.

Medical Direction

Cases that are performed personally generally are cut-and-dry in terms of coding simply report the appropriate procedure code along with modifier -AA. Some professionals seem to use the terms medical direction and medical supervision interchangeably, but they are definitely two distinct services that should be coded as such.

The Health Care Financing Administration (HCFA) has stipulated criteria (sometimes called the seven rules of medical direction) that the anesthesiologist must meet before a case can be considered medically directed. The physician should:

1. perform a pre-anesthesia examination and evaluation;
2. prescribe the anesthesia plan;
3. personally participate in the most demanding procedures of the anesthesia plan, including induction and emergence, if applicable;
4. ensure that any procedures in the anesthesia plan that he or she does not perform are performed by a qualified anesthetist;
5. monitor the course of anesthesia administration at intervals;
6. remain physically present and available for immediate diagnosis and treatment of emergencies; and
7. provide indicated post-anesthesia care.

Once these criteria have been met whether the case is truly medically directed hinges on how many cases are concurrent and how accurately the cases are documented. If a medically directed case ends at 10:01 a.m. and another case begins at 10:01 a.m., can these cases be considered concurrent for medical direction purposes? Some states such as Alabama and Minnesota say yes; other states like Georgia say no. Coders must be familiar with the guidelines in their state and follow the carriers stipulations, says Carol Kolbinger, owner of the compliance consulting firm Anesthesia Compliance Solution in Rogers, Minn.

A busy anesthesia group in a busy hospital may have so many cases going on that its difficult to keep track of how many are concurrent, she says. Its crucial for the anesthesiologist to note accurately the start and stop times of each procedure he or she is involved in to tell [...]