Modifier Coding Alert

You Be the Coder:

Choose QY for Medical Direction from an Anesthesiologist

Published on Fri Sep 19, 2014

Question: When would you use modifiers QY, QK, and AD? I am not understanding the use of these modifiers. For instance, if one of my physicians does a labor epidural (01967) and is directing a CRNA (01968), would I use 01967 with AA attached and 01968 with QY attached?

Oregon Subscriber

Answer: The key to determining the modifier for these two codes is whether your physician was supervising or directing the one certified registered nurse anesthetist (CRNA).

Medically directed anesthesia services are services performed by a CRNA or anesthesiology assistant (AA) and directed by an anesthesiologist who performs the pre-anesthesia exam and evaluation, prescribed the anesthesia plan, participates in the procedures, monitors frequently, remains physically present, and indicates post-anesthesia care.

Medically supervised anesthesia services are performed by a CRNA and is supervised by the attending physician who is responsible for reviewing and verifying the pre-anesthesia exam and evaluation, the anesthesia plan, and reviews and comments during the pre- and post-anesthesia care.

If your physician was supervising the CRNA, you’ll need modifier AD (Medical supervision by a physician: more than four concurrent anesthesia procedures).

If she was directing one CRNA, you would instead report the following codes:

01968 (Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia [List separately in addition to code for primary procedure performed]) with modifier QY (Medical direction of one certified registered nurse anesthetist [crna] by an anesthesiologist) attached
01968 with modifier QX (Crna service: with medical direction by a physician) attached.

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