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Wiki Aetna requiring anesthesia modifiers

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lcole7465

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I'm looking for an updated Aetna anesthesia policy for Ohio. We are getting denials for missing modifiers, The last update we had is that Aetna doesn't require anesthesia modifiers. Is there a link that I can go to provide the policy that they are now requiring these modifiers. The only thing I'm finding is a few years old and would like to find something more current. The representative we talked to is unwilling to provide us with the information.

Thanks
 
If you're in-network with Aetna, then you will need to use the anesthesia modifiers.

Modifier Description
AA Anesthesiologist only
QK Medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals
QS Monitored anesthesia care service (MAC)
QX CRNA service: with medical direction by a physician
QY Medical direction of one CRNA by an anesthesiologist
 
Lisa,

Do you know when this began. We've contacted the rep and they can't give an updated specific policy in regards to this. The spreadsheet the manager for the anesthesia department has provided shows that the claim is billed by the doctor only with no modifier. We are located in Ohio, if this makes a difference.

Thank you
 
Anesthesia Modifiers for Aetna in Oklahoma

I was doing follow up in anesthesia up until 2 months ago and switched to Pain Mgt. coding. So unless something has changed and it is different in Ohio, which I doubt it is since we all use the same CPT book/guidelines. You only need the AA modifier for Anesthesia services unless they preform MAC (monitored anesthesia care) and then it is a QS. The QY, QK and QX are only used for Medicare, Medicaid and United Healthcare, in this state.
As far as a link, I looked too and couldn't find one, but I don't have my Aetna log on at home with me. But you could check with Navinet, which I never used or Availity. They may have something... again don't have my log on info for them either. I'm surprised you didn't have to have the modifiers before. I know we have used them here for at least the 5 years I was in follow up. I will see if I can find something tomorrow and respond again, as soon as I can. If not there are much more experienced people on here than me that may be able to answer before I get a chance to look. Heather
 
lcole7465 said:
Lisa,

Do you know when this began. We've contacted the rep and they can't give an updated specific policy in regards to this. The spreadsheet the manager for the anesthesia department has provided shows that the claim is billed by the doctor only with no modifier. We are located in Ohio, if this makes a difference.

Thank you
Click to expand...

This is standard anesthesia billing/coding. It's for all payers and not exclusive to Aetna.
 
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