Get Full Reimbursement for Anesthesia Teaching Cases

Use the AA and GC modifiers to claim 100% reimbursement for your teaching anesthesiologists for cases performed after Jan. 1, 2010. That’s the date teaching anesthesiologists become eligible to receive full payment under the Medicare physician fee schedule (PFS) for cases where they supervise or medically direct anesthesia residents.

You won’t see receive the additional reimbursement without proper modifier use.  Use modifier AA (anesthesia services performed personally by anesthesiologist) to get 100% reimbursement. Don’t use the QK modifier, which indicates medical direction and pays only 50% of the allowed charge. Additionally, modifier GC (service performed in part by a resident under the direction of a teaching physician) indicates the teaching anesthesiologist was present or immediately available during all critical portions of the anesthesia procedure (i.e., induction, emergence).

The ASA created a teaching tool to help coders properly bill in cases where a teaching anesthesiologist is directing a resident or student-registered nurse anesthetist (SRNA).  The following is a list of medical direction scenarios provided by the ASA, with proper modifier usage:

• 1 MD + 1 Resident + medical direction of 1 CRNA in two separate concurrent cases = MD paid 100% of the allowed amount for the resident case (use the AA and GC modifiers) and 50% of the allowed amount for the CRNA case (with QK modifier). CRNA paid 50% of the allowed amount for his/her case (with QX modifier).
• 1 MD + 2 SRNAs in two separate concurrent cases = MD paid 50% of the allowed amount for each case. Note: MDs cannot be involved in more than two concurrent SRNA cases without a CRNA also being involved. Both cases filed with modifier QK.
• 1 MD medically directing 1 CRNA + 1 SRNA in two separate concurrent cases = MD paid 50% of the allowed amount for each case (bill with modifier QK); CRNA paid 50% of the allowed amount for his/her case (bill with modifier QX). No payment made for the SRNA service.
• 1 non-medically directed CRNA + 1 SRNA = CRNA paid 100% of the allowed amount (use QZ modifier).Note:Modifier GC is only used in working with a resident.
• 1 nonmedically directed CRNA + 2 SRNAs in separate concurrent cases = CRNA paid 100% of the allowed amount in each case (use QZ modifier).  The teaching CRNA must devote all his or her time to the two concurrent student nurse anesthetist cases.  To bill base units in each case, the teaching CRNA must be present with the student during the pre- and post-anesthesia care in each case.” 

Official resources:

For the CMS article describing the new rules for teaching anesthesiologists, go to: www.cms.hhs.gov/MLNMattersArticles/downloads/MM6706.pdf

For the ASA report describing different teaching anesthesiologist scenarios, go to: www.asahq.org/Washington/Payment%20Scenarios%20under%20Final%202010%20PFS.pdf