A major part of medical coding and medical billing services involves the use of modifiers. Modifiers are added to CPT and HPCS codes to provide detailed information for specialists like anesthesiologists.
A modifier is added to nearly every medical code. This is why the incorrect use of such modifiers can prove disastrous for healthcare facilities.
Here’s a refresher on using anesthesia modifiers correctly:
There are two main levels of modifiers, namely, Level I and Level II. The former is updated by the American Medical Association (AMA) and comprises of two numeric digits. The latter is maintained by the Centers for Medicare and Medicaid Services (CMS) and has two alpha digits.
Besides the levels of modifiers, billers and coders need to be aware of the two main categories these codes are divided into. These are informational modifiers and pricing modifiers.
Anesthesia Pricing Modifiers
Anesthesia billers can accurately prepare medical claim and billing documents using these modifiers. Pricing modifiers direct claims processing by identifying who performed the anesthesia service.
The following are some examples of pricing modifiers used in anesthesiology.
- AA—Used when an anesthesiologist personally performs anesthesia services.
- AD—Used when more than 4 anesthesia procedures are supervised by a physician.
- QK—Used when 3 or 4 anesthesia procedures are medically directed by a physician.
- QX—Used when an anesthesiologist’s assistant performs a service under the supervision of a physician.
- QY—Used when an anesthesiologist directs an assistant on a procedure.
- QZ—Used when a Certified Registered Nurse Anesthetist (CRNA) administers anesthesia withouta physician’s medical direction.
Anesthesia Informational Modifiers
As the name suggests, these modifiers are only used to extract information regarding procedures and are generally included after pricing modifiers are used. Although informational modifiers have no direct impact on the pricing and reimbursement process, they are important for accurate billing.
The following are examples of frequently used informational modifiers.
- QS—Used when monitored anesthesia care is provided with proper anesthesia codes and report times for claims processing.
- 23—Used when anesthesia is used for procedures that typically require little or no anesthesia. The anesthesiologist may administer a dose of general anesthesia under unusual circumstances.
Note: This modifier should not be reported with medical procedures whose code description includes the phrase ‘without anesthesia’.
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