When to use Anesthesia and HCPCS Modifiers?

What are Modifiers? 

Modifiers are two-character suffixes (alpha and/or numeric) that are attached to a procedure code. CPT modifiers are defined by the American Medical Association (AMA). HCPCS Level II modifiers are defined by the Centers for Medicare and Medicaid Services (CMS).

Modifiers should be used carefully with CPT or HCPCS codes, because they directly affect the dollar value of the procedure codes.

Modifiers altered the service or procedure performed, without changing the definition of the procedure. For example, the use of 26 or TC modifier with Radiology procedure codes, or the use of 25 and 27 modifier with E/M codes. The definition for procedure remains the same only the payment get affected or modified with the use of modifiers. Below are few more examples for use of modifiers:

To indicate a bilateral procedure, use 50 modifier 

To report multiple surgery procedure, use 51 modifier

To report the specific part of the body, like RT (right), LT (Left).

To report a reduce service, use 52 modifier

Read also: What is the main difference between 58, 78 and 79 modifier

When to use Anesthesia and HCPCS Modifiers?

What is Anesthesia Modifiers?

Anesthesia is the administration of a drug or anesthetic agent by an anesthesiologist or Certified Registered Nurse Anesthetist (CRNA) for medical or surgical purposes to relieve pain and/or induce partial or total loss of sensation and/or consciousness during a procedure. 

Anesthesia may be local or general anesthesia. In local anesthesia, only a specific part of body loses its sensation and rest of the body is active. While in general anesthesia, whole body is in unconsciousness mode for major surgeries.

In anesthesia every anesthesia procedure billed to Medicare must include one of the following anesthesia HCPCS modifiers:

               

AA: Anesthesia services performed personally by anesthesiologist or when an anesthetist assists a physician in the care of a single patient.

QY: Medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist

QK: Medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals.

AD: Medical supervision by a physician: more than four concurrent anesthesia procedures.

QX: CRNA (Certified Registered Nurse Anesthetist) service : with medical direction by a physician.

QZ: CRNA (Certified Registered Nurse Anesthetist) service : without medical direction by a physician.

Read also: When to use 62 and 80 Modifier

List of Physical Status Modifier for Anesthesia

Anesthesia procedures have their own special set of modifiers, which are simple and correspond to the condition of the patient as the anesthesia is administered. These codes are:

  • P1 – a normal, healthy patient (eg. Healthy, non-smoking, no or minimal alcohol use)
  • P2 – a patient with mild systemic disease (e.g. Mild diseases only without substantive functional limitations)
  • P3 – a patient with severe systemic disease (e.g. One or more moderate to severe diseases.)
  • P4 – a patient with severe systemic disease that is a constant threat to life (e.g. MI, CVA, TIA, or CAD/stents, sepsis, DIC, ARD or ESRD not undergoing regularly scheduled dialysis)
  • P5 – a moribund patient who is not expected to survive without the operation (e.g. ruptured abdominal/thoracic aneurysm, massive trauma, intracranial bleed with mass effect, ischemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction)
  • P6 – a declared brain-dead patient whose organs are being removed for donor purposes 

References: http://www.outsourcestrategies.com/blog/2017/06/what-are-anesthesia-and-hcpcs-modifiers-and-when-to-use-them.html

http://blog.supercoder.com/coding-questions-answers/correct-use-p-modifiers

 

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