Does it matter what position modifiers are submitted on an anesthesia claim?

Yes. Documentation modifiers must be submitted in the first position. The appropriate modifier from the list below must be submitted in the first position to indicate whether the service was personally performed, medically directed or medically supervised:

  • 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/AA (Anesthesiologist's Assistant) service without medical direction by a physician

If one of the following monitored anesthesia modifiers applies, it must be submitted as an additional modifier in the second position: 

  • QS - Monitored anesthesia care service
  • G8 - Monitored anesthesia care (MAC) for deep complex complicated, or markedly invasive surgical procedures
  • G9 - Monitored anesthesia care for patient who has a history of severe cardio-pulmonary condition

Processing delays and rejections may occur for claims submitted without the modifiers in the correct position.

Resource: CMS IOM Pub. 100-04, Chapter 12, Section 50 (PDF, 1.05 MB)

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