Anesthesia Coding Alert

Question: When an anesthesiologist is medically supervising less than four CRNAs would we use modifiers QY/QK for the physician?

Montana Subscriber

Answer: You include modifier QK (Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals) on the anesthesiologist’s claim when he or she provides medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals. You append modifier QY (Medical direction of one certified registered nurse anesthetist [CRNA] by an anesthesiologist) when the anesthesiologist provides medical direction for one certified registered nurse anesthetist (CRNA). If the anesthesiologist’s case load goes beyond overseeing four CRNAs, you’ll report each case as medical supervision with modifier AD (Medical supervision by a physician; more than 4 concurrent anesthesia procedures) instead of medical direction. 

Remember the performance modifier on the CRNA’s claim also changes, depending on a physician’s involvement. Append modifier QZ (CRNA service: without medical direction by a physician) or QX (CRNA service: with medical direction by a physician) to the CRNA claim.