Anesthesia Coding Alert

Modifiers:

Know the ABCs of CRNA-Associated Modifiers

Published on Fri Aug 09, 2024

Can you tell your QXs from your QYs?

While some private payers don’t recognize HCPCS Level II modifiers, Medicare and other payers do. So it’s vital you become familiar with six key Anesthesiologist and Certified Registered Nurse Anesthetist (CRNA) associated modifiers.

Here’s what you need to know about them. And as an added bonus, we’ve condensed all this valuable information into a handy clip-and-save for you to keep for easy reference.

Use AD for Supervision (Physician’s Claim)

Modifier AD (Medical supervision by a physician: more than four concurrent anesthesia procedures) indicates the anesthesiologist was either involved in more than four concurrent rooms or cases (regardless of type of insurance) or failed to meet the medical direction steps in some states.

Append QK or QY for CRNA Direction for 50 percent (Physician’s Claim)

When you report medical direction with modifiers QK (Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals) or QY (Medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist), payment is divided equally (50 percent each) between the anesthesiologist and the CRNA.

Append QX for CRNA for 50 percent (CRNA’s Claim)

When you report medical direction with modifier QX (Qualified non-physician anesthetist with medical direction by a physician), payment is divided equally (50 percent each) between the anesthesiologist and the CRNA or Certified Anesthesia Assistant (CAA).

Remember: When a CRNA is employed by a hospital and a separate anesthesia group is medically directing, reimbursement is shared in some cases, and non-existent in others, depending on several factors noted above.

Apply QZ for 100 Percent CRNA Services (CRNA’s Claim)

When a CRNA is non-medically directed, full payment (100 percent) is paid to the CRNA or the entity to which they have reassigned their payment. To indicate this, you’ll add QZ (CRNA service: without medical direction by a physician) to the claim. However, some carriers, such as Horizon Blue Cross Blue Shield (HBCBS) in New Jersey, will deny QZ services and deem them not eligible.

Avoid Q6 for Short-Term CRNA Services (Physician’s Claim)

Although short-term contract or temporary CRNA’s are called locum tenens, you should not use a locum tenens modifier such as Q6 (Service furnished under a fee-for-time compensation arrangement by a substitute physician …) to receive payment for CRNA services, since by definition the modifier indicates the service was provided by a physician.

However, as to be expected in the world of anesthesia billing, there are no absolutes. If a payer policy requires reporting anesthesia claims in a specific manner — even if it makes no sense — you should follow their policy.