Pain Management and Anesthesia Modifiers
Pain Management and Anesthesia Modifiers
Anesthesia modifiers are used to receive the correct payment of anesthesia services. Pricing modifiers must be placed in the first modifier field to ensure proper payment (AA, AD, QK, QX, QY, and QZ). Informational modifiers are used in conjunction with pricing modifiers and must be placed in the second modifier position (QS, G8, G9, and 23).
| Modifier | Modifier Description |
|---|---|
| AA | Anesthesia services performed personally by an anesthesiologist |
| AD | Medical supervision by a physician; more than four concurrent anesthesia procedures |
| G8 | Monitored anesthesia care (MAC) for deep complex, complicated or markedly invasive surgical procedure |
| G9 | Monitored anesthesia care (MAC) for a patient who has a history of severe cardiopulmonary condition |
| QK | Medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals |
| QS | Monitored anesthesia care service |
| QX | CRNA service; with medical direction by a physician |
| QY | Medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist |
| QZ | CRNA service; without medical direction by a physician |
| 23 | Unusual anesthesia – Used to report a procedure which usually requires either no anesthesia or local anesthesia; however, because of unusual circumstances must be done under general anesthesia. Coverage/payment will be determined on a “by-report” basis. |
| 47 | Anesthesia by surgeon – Used to report regional or general anesthesia provided by the surgeon (Not covered by Medicare). |
| P1 – P6 | Physical Status Modifiers (Not used by Medicare) |
Modifier 47
Anesthesia by Surgeon
Instructions
- Surgical allowable based on 50 percent of Medicare Physician Fee Schedule (MPFS)
Correct Use
- Regional/general anesthesia provided by surgeon/attending surgeon only
- Append to basic surgical service/procedure only
Incorrect Use
- Surgeon performs both surgery/anesthesia, separate payment not allowed
- Anesthesiologist not covered with this modifier
- Do not use with anesthesia codes or local anesthesia
- Do not use with moderate sedation (CPT 99143 – 99145)
- Do not use for monitoring general anesthesia provided by Certified Registered Nurse Anesthetist (CRNA), intern, anesthesiologist or resident
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