Anesthesia Coding Alert

Question: I’m coding for an anesthesiologist with two concurrent cases – one with a resident and the other with an SRNA. I’m having trouble finding an example of this situation. What would be the correct modifier for the anesthesiologist?

Illinois Subscriber

Answer: The service qualifies as medical direction since the anesthesiologist had only two concurrent cases involving other qualified providers.

For both of the anesthesiologist’s claims, report the appropriate anesthesia code and append modifier QK (Medical direction of 2, 3 or 4 concurrent procedures involving qualified individuals). On the claim for the resident, append modifier GC (This service has been performed in part by a resident under the direction of a teaching physician) to show that his or her work was under the direction of a teaching physician. CMS does not require modifier GC for SRNA services because the modifier description pertains to residents. Payment for these services may be 50% of the expected allowables, depending on the type of insurance.

Pay attention: The correct modifier changes when the anesthesiologist is medically directing only one resident or SRNA. In that situation, append modifiers AA (Anesthesia services performed personally by anesthesiologist) and GC for a one-to-one case with a resident and modifier AA for a one-to-one case with a SRNA to the anesthesiologist’s claim. Payment for each of these scenarios should be 100 percent of the expected allowable.