Include the applicable modifier for the physician’s
medical direction or supervision on each claim!
Confused whether you should report an
anesthesiologist’s case as medically directed or medically supervised? You’re not alone; even the most experienced
coders struggle with this. Not knowing this can make or mar your practice’s
bottom-line.
Here are some basics about medical direction vs.
medical supervision that will help you handle the situation:
Classify Direction/Supervision
Correctly
Verify the
number of concurrent cases the anesthesiologist was involved in at the
time. The modifiers that designate
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
Important: Concurrent anesthesia procedures are those that overlap –
even if only by a minute. Once the anesthesiologist oversees more than four
concurrent anesthesia procedures, he shifts from medical direction to medical
supervision. Medical supervision also applies if the anesthesiologist doesn’t
meet all seven criteria for medical direction.
Payment Info
If the anesthesiologist meets all criteria for providing
medical direction, each procedure he directs pays 100 percent (which is split
50/50 between the physician and CRNA). For medical supervision, payment is
usually based on three units (including one additional unit if the
anesthesiologist took part in induction) for the physician and 50 percent for
the CNRA.
Here’s what you can do: Instead of doing it yourself, let the payer adjust
the number of units for the anesthesiologist. Make sure you check your local
guidelines for specific instructions and know that Medicare will reduce the
units when appropriate. Add the correct modifier for the physician’s medical
direction or supervision on each claim the anesthesiologist files.
Get more
anesthesia coding and reimbursement guidance to ensure optimal payments in SuperCoder Anesthesia Coding Alert.
