Wiki QY and QX versus QZ

[Jennifer Moore]

Can anyone tell me if there is anything needed to prove the reason we bill using QY and QX? One for the provider and the other for the CRNA? Is there something I should be using along with these codes in order to get both paid? I do not agree using these modifiers when the doctor that is medically directing the CRNA is also the surgical doctor.

Thanks,
Jennifer

 

[Michele Hannon]

A surgeon does not typically medically direct. Some states Scope of Practice for Nurse Anesthetists require a supervising physician which can be the surgeon.

Should use QZ for the non-medically directed CRNA to get 100% reimbursement even if the surgeon is supervising. Not sure what you mean by "to get both paid"? Is the anesthesia service on the provider's claim? What kind of anesthesia is being reported?

 

[Melissa*Ever*Evolving]

If the supervising provider is the surgeon, you must bill the CRNA's charges as -QZ and this will be filed under their billing information. (gets 100% of fee schedule)

The only time you should bill the -QY/-QX is when an anesthesiologist is "Medically Directing" the CRNA (or AA). (gets split 50%/50% of fee schedule)

Some State's Medicaid Programs are requiring additional U modifiers to report with these Q modifiers to furthur explain the situation. You may want to look at the insurance provider's guidelines to make sure all requirements are being followed. Also, you may want to check the "medically directing" definition just to be sure all requirements there are covered.

I hope that helps a little!

~Melissa, CPC

 

[Jennifer Moore]

Thank you for this information, it helps so much.