Modifiers
that indicate whether the anesthesiologist supervised or directed are QY, QK,
and AD.
Do
you sometimes find yourself in a fix whether you should report an
anesthesiologist’s case as medically directed or medically supervised? You’re
not alone. Even the most experienced coders get
caught in the medical direction vs medical supervision confusion. Here are some
basics about medical direction/supervision with a common scenario to help you
handle such confusions better:
Categorize
Correct Direction/Supervision
The first thing you need to do is
verify the number of concurrent cases the anesthesiologist was involved in at
the time. The modifiers that point to whether the anesthesiologist supervised
or directed are:
·
QY – Medical direction of one
certified registered nurse anesthetist (CRNA) by an anesthesiologist
·
QK – Medical direction of two,
three, or four concurrent anesthesia procedures involving qualified individuals
·
AD – Medical supervision by a
physician; more than 4 concurrent anesthesia procedures.
Points
to note:
Concurrent anesthesia procedures are those that overlap – that could mean even
by a minute. The anesthesiologist moves from medical direction to medical
supervision after he oversees more than four concurrent anesthesia procedures.
Medical supervision also applies if the anesthesiologist does not meet all
seven criteria for medical direction.
Payments
for medical direction:
If the anesthesiologist meets all
criteria for providing medical direction, each procedure he directs reimburses
100 percent. (This is split 50/50 between the physician and CRNA).
Payments
for medical supervision:
Payment for medical supervision
is based on three units. (in addition to one more unit if the anesthesiologist
took part in induction) for the physician and 50 percent payment for CRNA.
Heed
this advice:
Instead of taking it up yourself, let the payer adjust the number of units.
Check your guidelines for specific instructions and be prepared that Medicare
will reduce the units for you whenever it feels is applicable. Include the
appropriate modifier for the physician’s medical direction or supervision on
each claim the anesthesiologist files. Additionally, you could consider
investing in an SuperCoder Anesthesiacoding resource
to help you overcome difficult anesthesia
coding scenarios with guidance on medically directed vs medically supervision
confusions, qualifying circumstances codes, anesthesia modifiers, base units, 2014 performance measurement codes, post-op
blocks, and more.
Here’s a
scenario to further help your understanding of medical direction/supervision:
In
an office setting, your providers offer kyphoplasty.
The physician performs the kyphoplasty and the CRNA administers anesthesia.
How to code this?
The
anesthesiologist will report the correct procedure code(s) for the kyphoplasty (22523-+22525) while the CRNA will report the anesthesia with 01936 (Anesthesia for percutaneous image guided procedures on the spine
and spinal cord; therapeutic). Do not report a medical direction/supervision
modifier for the anesthesiologist since a physician cannot personally perform a
procedure while medically directing or supervising a CRNA.
But note: You should add modifier QZ to the CRNA’s claim.
