Anesthesia Coding Alert

Question: I’m still fairly new to anesthesia coding and want to be sure I’m adding the correct modifiers to our CRNA’s claims (and the anesthesiologist) when I report medical direction. Can you explain them to me?

Alabama Subscriber

Answer: You’re thinking about the right things when wanting to be sure you report the correct modifiers for both your providers. When submitting claims involving medical direction, you’ll choose from certain modifiers for the anesthesiologist and others for the CRNA.

If the anesthesiologist is medically directing only one CRNA, append modifier QY (Medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist).  Use QK (Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals) when the anesthesiologist is medically directing two, three, or four concurrent anesthesia cases.

From the CRNA perspective, modifier QX (CRNA service: with medical direction by a physician) applies when the CRNA is medically directed by an anesthesiologist. If the CRNA provides anesthesia in the absence of an anesthesiologist, append modifier QZ (CRNA service: without medical direction by a physician) instead.

Caveat: These modifiers apply when the anesthesiologist’s services meet the criteria for medical direction. Different modifiers come into play when the anesthesiologist is providing medical supervision instead.