Anesthesia Coding Alert

Question: We've never reported modifier AD, but recently had a situation where our anesthesiologist was supervising five CRNAs concurrently. How does this affect our reimbursement, and does reporting AD raise a red flag with Medicare?

New York Subscriber

Answer: This situation comes along periodically, so it shouldn't garner extra attention from your payers. According to Medicare guidelines, "Carriers may allow only three base units per procedure when the anesthesiologist is involved in furnishing more than four procedures concurrently or is performing other services while directing the concurrent procedures. An additional time unit may be recognized if the physician can document he or she was present at induction."

Translation: Medicare requires modifier AD (Medical supervision by a physician: more than 4 concurrent anesthesia procedures) when the situation merits it. If some of the cases involve other payers, try to find out if they accept modifier AD before submitting the claim.

Payment cut: Your anesthesiologist will not receive payment for his time, no matter how long he spends on each of the AD cases. To get paid for the additional "time unit" mentioned in the guidelines, you must confirm and report that the physician was present at induction and enter a note in box 19 of the paper claim (or your electronic equivalent for notes).

Track payments for each modifier AD claim and show your physicians how medical supervision cases impact  revenue. Sometimes your anesthesiologist can't avoid crossing into modifier AD territory; but if he sees how it affects the bottom line he might try harder to avoid being caught in those situations.