Anesthesia Coding Alert

Question: I know that if the anesthesiologist medically directs more than four concurrent cases, we should append modifier AD for medical supervision. How do we handle it when he medically supervises less than four CRNAs or AAs? Would we include modifier QK, or modifier AD?

Delaware Subscriber

Answer: Base your modifier on the number of concurrent cases the anesthesiologist supervises or directs. For a single case, submit the appropriate anesthesia code with modifier QY (Medical direction of one certified registered nurse anesthetist [CRNA] by an anesthesiologist). For two, three, or four concurrent cases, append modifier QK (Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals). For more than four concurrent cases, append modifier AD (Medical supervision by a physician: more than four concurrent anesthesia procedures).

Note: The anesthesiologist provides the same type of service in each of these situations. The terminology changes from "medical direction" to "medical supervision" when the anesthesiologist reaches four or more concurrent cases.

Carriers sometimes have different guidelines for reporting medical supervision. Check with your Medicare representative to confirm the correct filing.