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 [...]