Anesthesia Coding Alert

Question: I have a two-part question about medical supervision and using the -AD modifier. 1.) Are we required to bill only three base units for each of the cases involved when there are more than four concurrent cases? 2.) If one of the cases is an emergency or an unscheduled procedure (such as an obstetrical delivery), must we still use -AD?

Pennsylvania Subscriber

Answer: The base units for procedures are established by the American Society of Anesthesiologists (ASA) and/or the Health Care Financing Administration (HCFA). You can bill the usual, customary and reasonable fee if you participate with Medicare; most anesthesiologists do. Medicare will make the adjustments based on the modifiers, concurrency, etc. Four or more concurrent cases are four or more cases, regardless of whether they are emergencies, ob or regularly scheduled cases. Medicare makes no additional allowances for emergency circumstances and does not accept qualifiers. If your state accepts -AD (medical supervision by a physician: more than four concurrent anesthesia procedures), you must use it when filing claims to which it applies.