Wednesday, February 17, 2010

Medicare Part B - Modifiers - Anesthesia

Introduction

A list of the most frequently used CPT (Current Procedural Terminology) modifiers, HCPCS
(Healthcare Common Procedure Coding System) modifiers, and local modifiers has been
compiled for your reference.

These modifiers and associated nomenclature emanated from two different sources.

Physician’s Current Procedure Terminology, CPT 1999 was used for the definition of CPT4
numeric modifiers with one modification. The five digit modifiers identified in the CPT
are not included in these definitions since the Medicare program does not recognize
reporting modifiers in this format.

The HCPCS (Healthcare Common Procedure Coding System) alpha modifiers were
developed by Centers for Medicare & Medicaid Services (CMS) for use in the Medicare
program.

For some of these modifiers, additional clarification (shown as indented text) has been added,
as well as examples. Other modifiers are self-explanatory; no additional comment is provided.

Modifiers provide the means by which the reporting provider can indicate a service or procedure
that has been performed has been altered by some specific circumstance but not changed in
its definition or code.

Modifiers may be used to indicate that:

a service or procedure has both a professional and technical component
a service or procedure was performed by more than one physician
a service or procedure has been increased or reduced
only part of a service was performed
an adjunctive service was performed
a bilateral procedure was performed
a service or procedure was provided more than once
unusual events occurred


Anesthesia

One of the following modifiers must be reported with anesthesia services to indicate who
performed the anesthesia service:

AA Anesthesia services performed personally by anesthesiologist
AD Medical supervision by a physician: more than four concurrent anesthesia procedures
QK Medically directed by a physician: two, three, or four concurrent procedures
QY Anesthesiologist medically directs one CRNA
QX CRNA service: with medical direction by a physician
QZ CRNA service: without medical direction by a physician
The following modifiers can be reported in the 2nd position under appropriate circumstances
in addition to one of the previous anesthesia modifers:

QS Monitored anesthesia care service
23 Unusual anesthesia
Note: When using modifier 23, appropriate documentation must be submitted with the
claim.

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