Anesthesia coding and billing require great attention to detail. Not only is documentation, start and stop times, and code choice critical, but so are determining the correct modifiers, correctly implying the patient’s physical condition, and recording any other qualifying situations that may affect how claims are compensated.
This article provides a refresher on anesthesia modifiers, physical status, and qualifying situations, whether you are new to anesthesia coding and billing or an experienced professional.
Anesthesia Modifiers
Modifiers are two-digit codes added to CPT and HCPCS codes to provide further data. They are divided into two categories and two levels. The American Medical Association maintains and updates Level I modifiers with two numeric digits (AMA). The Centers for Medicare and Medicaid Services maintains and updates Level II Modifiers with two alpha digits (AA through VP). Pricing and informational modifiers are the two types of modifiers. Pricing modifier keys should always be used first, accompanied by informational modifiers.
A modifier is attached to nearly every anesthesia code that is billed. According to Medicare Administrative Contractor WPS GHA, the inaccurate use of modifiers is regularly among the top billing issues for federal, government, and private payers.
The anesthesia pricing modifiers listed below indicate who provided the anesthesia service and who should be invoiced in the first modifier profession.
AA – Personal anesthesia services provided by an anesthesiologist.
AD – A physician medically monitors more than four simultaneous anesthesia procedures.
QK – Medical supervision of two, three, or four concurrent anesthesia processes by a health care professional.
QY – An anesthesiologist oversees one CRNA/AA (Anesthesiologist’s Assistant).
QX – CRNA/AA service under the supervision of a doctor.
QZ – CRNA service provided without the supervision of a physician.
