Anesthesia Coding Alert

Question: Does Florida Medicaid require a modifier when an anesthe­siologist personally performs the anesthesia service? The Medicaid manual does not mention an -AA modifier.

Florida Subscriber

Answer: No. Florida Medicare — First Coast Services Options, Inc. — requires the personally performing modifier AA (Anesthesia services performed personally by anesthesiologist); however, Florida Medicaid does not recognize this modifier for payment purposes and will deny the claim. The exception to this rule is when the Medicaid claim is secondary to Medicare and modifier AA is dropped in the crossover.

According to Florida’s Medicaid policy, the agency will only accept three modifiers for anesthesia services. Its anesthesia services coverage policy notes that providers must include the following modifiers, as appropriate, on the claim form:

• 78 (Unplanned return to the operating/procedure room by the same physician … following initial procedure for a related procedure during the postoperative period)
• QK (Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals)
• QS (Monitored anesthesia care service)

To ensure accurate claims processing, you should routinely spot-check payments and denials.

Resource: Find Florida Medicaid coverage specifics at https://ahca.myflorida.com/medicaid/rules/adopted-rules-service-specific-policies.