Introduction Concurrent Modifiers?

Some third-party payers require additional modifiers to indicate how many cases an anesthesiologist was performing or directing at one time. Certified registered nurse anesthetists (CRNAs) may administer anesthesia to patients under the direction of a licensed physician, or they may work independently. An anesthesiologist may medically direct up to four cases at the same time (concurrently). If a physician directs more than four cases, it is referred to as medical supervision. Medical direction means the directing anesthesiologist is present at the induction and emergence from anesthesia, for all key portions of the procedure, and is immediately available in case of an emergency. The CRNA would be with the patient the entire time.

Read also: List of HCPCS modifiers

Read also: When should we use 3 modifiers together with a CPT code

Rules of CMS

When medical direction occurs, certain documentation must be submitted for services for Medicare patients. The documentation must support that certain services were personally performed by the physician. These include:
1. Pre-anesthesia examination and evaluation
2. Prescription of an anesthesia plan
3. Personally participates in the most demanding procedures in the anesthesia plan, including induction and emergence
4. Ensures that any procedures in the anesthesia plan that he or she does not perform are performed by a qualified anesthetist
5. Monitors the course of anesthesia administration at frequent intervals
6. Remains physically present and available for immediate diagnosis and treatment of emergencies

Additional modifiers that define the types of providers involved in anesthesia are:

-AA Anesthesia services performed personally by an anesthesiologist
-AD Medical supervision by a physician; more than 4 concurrent anesthesia procedures
-G8 Monitored anesthesia care (MAC) for deep, complex, complicated, or markedly invasive surgical procedure
-G9 Monitored anesthesia care for patient who has a history of severe cardiopulmonary condition
-QK Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals
-QS Monitored anesthesia care service
-QX Certified registered nurse anesthetist (CRNA) service, with medical direction by a physician
-QY Medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist
-QZ CRNA service, without medical direction by a physician

These modifiers are not CPT modifiers but HCPCS modifiers and further define the anesthesia services provided. Anesthesia modifiers are always placed first after the CPT anesthesia code. These anesthesia
modifiers are pricing modifiers and are listed first to assure correct reimbursement.