Anesthesia Coding Alert

Question: I’m preparing a claim for our anesthesiologist with more than four concurrent cases. What are the current Medicare rules for this? Do I reduce the units, or does Medicare?

Iowa Subscriber

Answer: Your first step is to always add modifier AD (Medical supervision by a physician; more than 4 concurrent anesthesia procedures) to any claim when the anesthesiologist reports more than four concurrent cases.

Units change: Payers may allow only three base units per procedure when the anesthesiologist is involved in more than four procedures concurrently or performs other services while directing the concurrent procedures. The payer might recognize an additional time unit if the physician can document that he or she was present at induction.

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).”

Verify: 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. If you employ the CRNA whose work the anesthesiologist was directing, be sure to append a QX modifier (CRNA service: with medical direction by a physician) to report their services and verify that documentation supports the medical direction requirements.