Anesthesia Coding Alert

Question: How do the anesthesia modifiers help us to differentiate between medical direction vs. medical supervision?

Virginia Subscriber

Answer: The first step is to identify the number of concurrent cases in which the anesthesiologist was involved in at that particular time. Remember that concurrent anesthesia procedures are those that overlap, even by one minute, and include all cases – not just Medicare. The medical direction status shifts to medical supervision once the anesthesiologist oversees more than four concurrent anesthesia procedures.

Your modifier choices to 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.

Remember: If it is medical direction, each procedure the anesthesiologist directs is reimbursed 100 percent (which will split 50/50 between the physician and CRNA). While for medical supervision, it is normally based on three units (plus one additional unit if the anesthesiologist participated in induction) for the physician and 50 percent payment for the CRNA.