Part B Insider (Multispecialty) Coding Alert

Published on Thu Feb 13, 2014 PDF

Plus: Know when exceptions might apply.

Before appending modifiers QY (Medical direction of one certified registered nurse anesthetist [CRNA] by an anesthesiologist) or QK (Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals) to your anesthesiologist’s claim, verify that he or she meets all seven criteria  necessity. Also know that certain services can be performed without interrupting medical direction, keeping your reimbursement at a higher level.

The seven criteria for claiming medical direction are:

• Perform a pre-anesthesia evaluation
• Prescribe an anesthesia plan
• Personally participate in the key components of the case, including procedures as well as induction and emergence
• Ensure that all additional procedures (such as line placements) are performed by only the anesthesiologist or qualified anesthetist
• Monitor the course of anesthesia administration at regular intervals
• Be physically present and/or available to address any emergencies that might arise
• Provide post-anesthesia care.

CMS does allow for a few exceptions to these criteria:

• Addressing an emergency of short duration within the immediate area
• Administering an epidural for labor pain
• Periodic monitoring of an obstetrical patient.

If you’re uncertain regarding whether a situation meets the criteria or falls under an exception, always check with your local payer before submitting the claim.