Anesthesia Coding Alert

Question: I'm still learning the ins and outs of anesthesia coding. What are Medicare's rules when our anesthesiologist bills more than four concurrent cases? Do we reduce the units, or does Medicare?

South Carolina Subscriber

Answer: The first thing you do when the anesthesiologist reports more than four concurrent cases is append modifier AD (Medical supervision by a physician; more than 4 concurrent anesthesia procedures) to each claim.

Units drop:  Be aware that payers might allow only three base units per procedure when the anesthesiologist is involved in more than four concurrent procedures or when he or she 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)."

Details: 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 who is being directed by the anesthesiologist, be sure to append modifier QX (CRNA service: with medical direction by a physician) to report their services and verify that documentation supports the medical direction requirements.