Question multiple modifiers


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We are billing for anesthesia and have a Blue Shield claim which has the need for 5 modifiers. I understand the claim only allows for 4 modifiers however, all 5 modifiers are important in the correct processing and payment on this claim.
Has anyone experienced this and how do you report this situation.
Here is the coding: 00811 AA GC QS PT P3
The procedure was done with an anesthesiologist directing a resident (AA GC) with monitored anesthesia (QS) and a screening colonoscopy converted to a diagnostic colonoscopy (PT) with a physical status of 3 (P3).
I feel all five modifiers are needed in this situation.
Anyone have any input on what to do for reporting this as again the claim form only allows for 4 modifiers.

Thank you for your help and response on this is greatly appreciated!

CherylB :)