Anesthesia Coding Alert

Question: Our anesthesiologist is billing more than four concurrent cases. How do we file this claim to Medicare? Do we reduce the units, or does Medicare?

South Carolina Subscriber

Answer: When the anesthesiologist reports more than four concurrent cases, always include modifier AD (Medical supervision by a physician; more than 4 concurrent anesthesia procedures) on each claim. Report modifier QX (CRNA service: with medical direction by a physician) for the medically directed CRNA on that claim.

Be aware: Payers may allow only three base units per procedure when the anesthesiologist is involved in more than four procedures concurrently or performed other services while directing the concurrent procedures. The payer might recognize an additional time unit if the physician can document that they were present at induction for general anesthesia. CMS has previously clarified that “the carrier should allow three base units plus one time unit if the physician is present at induction (and reports the AD modifier).”

Check your local guidelines for specific instructions and know that Medicare will reduce the units for you when applicable -- you don’t need to do it yourself.