One look at
the medical billing process, and it’s no wonder so many mistakes are made. With
so many different codes for each medical procedure and the numerous modifiers
indicating special circumstances under which the procedure was performed,
billers have a difficult task documenting everything properly. For companies
providing healthcare for their employees, this often leads to increased costs
due to incorrect billing from medical providers.
For this
reason, it’s important that businesses get educated about medical bill coding
or, at the very least, partner with a bill auditing company with expertise in
this area. Proper medical bill reviewing is the only way to ensure incorrect
charges are caught, challenged and corrected. Otherwise, you’re blindly paying
medical bills and likely wasting a lot of money.
One class of
modifiers that commonly confuses billers and leads to misuse is anesthesia
modifiers. Used for the billing of anesthesia services, these modifiers are
used to indicate which medical professional was administering the services.
These conditions determine at what rate the services are billed.
Here’s what
you need to know about anesthesia modifiers for medical bill coding:
- Modifier AA is used when a medical doctor (MD) performs the anesthesia service independently. This is to be pad at 100 percent of fee schedule value. If no modifier is billed, AA is assumed.
- Modifier QZ is to be used when a CRNA (Certified Registered Nurse Anesthetist) performs the anesthesia service independently. This is to be paid at 100 percent of fee schedule value. If no modifier is billed, Modifier QZ is assumed.
- Modifier QK is to be used when a medical doctor (MD) oversees two to four concurrent anesthesia procedures. This is to be paid at 50 percent of fee schedule value.
- Modifier QX is to be used when a CRNA performs the service under the supervision of an MD. This is to be paid at 50 percent of fee schedule value.
Now that you
have a basic understanding of the main anesthesia modifiers, let’s take a look
at some examples of correct and incorrect billing.
Correct billing:
--Dr. Smith,
MD, CPT 01630-AA, payment made at 100 percent of fee schedule value
Correct billing:
--Dr. Smith,
MD, CPT 01630-QK, payment made at 50 percent of fee schedule value
--Mike
Jones, CRNA, CPT 01630-QX, payment made at 50 percent of fee schedule
Incorrect billing:
--Dr. Smith,
MD, CPT 01630, payment made at 100 percent of fee schedule
--Mike
Jones, CRNA, CPT 10630-QX, payment made at 50 percent of fee schedule
The reason
the last example is incorrect is because the doctor should have applied
modifier QK and been paid at at 50 percent of fee schedule value. A mistake
like this could easily be overlooked, and your company could end up paying more
than required due to a billing error and oversight.
That’s why
it’s so important that businesses have a medical bill auditing plan in place,
ensuring any such mistakes are caught, challenged and corrected to avoid
excessive fees.
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ReplyDeleteAnesthesia modifiers are an essential part of medical coding services and can be a confusing and complex area for both medical professionals as well as business owners. From correctly billing for anesthesia services to determining the rate at which they will be paid, it is vitally important to understand how these modifiers work and when they should be applied. Knowing this information can save your business money and help you get the most out of your medical billing services efforts.
ReplyDeleteCorrect use of anesthesia modifiers can go a long way toward ensuring accuracy in medical bill coding, which leads to better reimbursements for services rendered. By understanding how these modifiers work and when they should be applied, both healthcare providers and businesses providing health insurance to employees can make sure they are getting the most out of their billing process. If you have any questions about your medical bill coding and anesthesia modifiers, it’s best to consult a professional Medical billing company