Modifiers QK, QY, QX, QZ
Modifiers are reported to identify anesthesia provider(s) involved in the case. In many instances, there are multiple providers involved with anesthesia cases. HCPCS Level II modifiers for anesthesia providers include:
• QK Qualified Individual who is medically directing two to four concurrent procedures
• QY An anesthesiologist that medically directed a CRNA in a single case
• QX A medically directed CRNA
• QZ CRNA who is performing anesthesia services without medical direction by a physician
In some cases, more than one provider delivers anesthesia services. For example, an anesthesiologist performs medical direction for a CRNA. The anesthesiologist reports the anesthesia code with modifier QK if he is medically directing two to four concurrent cases. The CRNA reports the same anesthesia code with modifier QX. For the CRNA’s claim, it is not necessary to know exactly how many anesthesia cases the anesthesiologist is medically directing. We need to know the CRNA is being medically directed. To determine the correct modifier for the anesthesiologist, the numbers of concurrent cases being directed must be known.
There are seven elements that are required by Medicare to report medical direction. The elements include: Performs pre-anesthetic exam and evaluation; prescribes the anesthesia plan; personally participates in the most demanding procedures in the anesthesia plan; ensures any procedures that are not personally performed are performed by a qualified individual (AA, CRNA, residents); monitors the course of anesthesia in frequent intervals; remains physically present and available for emergencies; and provides indicated postoperative care.