Documentation Modifiers direct prompt and correct payment of the anesthesia claims submitted. Documentation modifiers (AA, QK, AD, QY, QX and QZ) must be billed in the first modifier field.
If a QS modifier applies, it must be in the second modifier field. Processing delays and denials may occur for claims submitted without the modifiers in the correct position.
Anesthesia documentation modifiers that MUST be billed in the first position:
AA – Anesthesia services performed personally by an anesthesiologist.
QK – Medical direction by a physician of two, three, or four concurrent anesthesia procedures.
AD – Medically supervised by a physician, more than four concurrent anesthesia procedures.
QY – Medical direction of one CRNA/AA (Anesthesiologist's Assistant) by an anesthesiologist.
QX – CRNA/AA (Anesthesiologist's Assistant) service with medical direction by a physician.
QZ – CRNA service without medical direction by a physician.
Effective November 13, 2001, CMS established an exemption for Certified Registered Nurse Anesthetists (CRNAs) from the physician supervision requirement. This exemption recognized a Governor's written request to CMS attesting that he or she is aware of the State's right to an exemption of the requirement and that is in the best interests of the State's citizens to exercise this option.
As of September 2014, seventeen States have chosen to opt-out of the CRNA physician supervision regulation.
The States are California, Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, Kansas, North Dakota, Washington, Alaska, Oregon, South Dakota, Wisconsin, Montana, Colorado, and Kentucky.
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