Anesthesia Coding Alert

Question: If a physician is medically directing one CRNA and one anesthesia assistant, are they looked upon the same in terms of modifiers? Do we use modifier QK modifier for the anesthesiologist and QX for both the CRNA and anesthesia assistant?

Ohio Subscriber

Answer: Anesthesiologist assistants (AA) work under direct supervision of an anesthesiologist performing support functions that don’t require the skills of a doctor, while ensuring doctors are there in case of an emergency. Sometimes you report different modifiers for an AA and a CRNA, but sometimes the modifier is the same. In your scenario, you are correct in thinking you’ll append modifier QX (CRNA service: with medical direction by a physician) for both the AA and the CRNA.

Remember that a CRNA can provide non-medically directed services, but an AA requires medical direction. Two other modifiers you’ll use for their services at different times are:

• QY – Medical direction of one qualified non-physician anesthetist by an anesthesiologist
• QZ – CRNA service: without medical direction by a physician.