Modifiers

BCBS covered anesthesia Modifier list

by Niels
Anesthesia Modifiers Modifiers are two-digit indicators that are used with a procedure code to add specific meaning to a service provided. Every anesthesia administrative code billed to BCBSF must include a modifier. More than one modifier can be submitted per detail line; however, the BCBSF claims system will adjudicate the claim based only on the ... Read More

Teaching Anesthesiologist service – GC modifier

by Niels
Anesthesia Services and Teaching Anesthesiologist If a teaching anesthesiologist is involved in a single procedure with one resident, the anesthesia services will be paid at the personally performed rate. The teaching physician must document in the medical records that he or she was present during all critical (or key) portions of the procedure. The teaching ... Read More

Anesthesia cpt code procedure qualifiying factor and description units.

by Niels
Procedure Codes and Modifiers Anesthesia providers are required to utilize the appropriate anesthesia code identified in the current Relative Value Guide published by the American Society of Anesthesiologists. Time in attendance should be billed by listing total minutes HP will calculate total units by dividing the total minutes (reported in block 24G) by 15, rounding ... Read More

Anesthesia modifier – where to report in CMS 1500 and electronic loop

by Niels
Informational (No additional payment for informational modifiers)Modifier Description G9 Monitored Anesthesia Care (MAC) for patient who has history of severe cardiopulmonary condition P1 A normal healthy patient P2 A patient with mild systemic disease P3 A patient with severe systemic disease P4 A patient with severe systemic disease that is a constant threat to life ... Read More

Anesthesia modifier with example – Modifier description

by Niels
Modifiers Modifiers are two-digit indicators used to modify payment of a procedure code, assist in determining appropriate coverage or otherwise identify the detail on the claim. Every anesthesia procedure billed to Medicare must include one of the following anesthesia modifiers: AA, QY, QK, AD, QX or QZ. The other modifiers listed below may be used ... Read More

Anesthesia billing – Supplies and Drugs Modifiers – ZM, ZN

by Niels
Supplies and Drugs Modifiers Medi-Cal providers must bill with the following modifiers for supplies and drugs used in performing surgical procedures (CPT-4 codes 10000 – 69999): Modifier    Definition     ZM –   Supplies and drugs used in this surgical procedure with other than general anesthesia or no anesthesia.   ZN  –   Supplies and drugs ... Read More

Emergency Anesthesia Modifier – ZB, cpt Q5102, Q9981

by Niels
Emergency Anesthesia Modifier:  Healthy Patient Modifier -ZB may be used to bill for anesthesia services during an emergency procedure on an otherwise healthy or medically stable and uncompromised patient.  Examples of the appropriate use of modifier -ZB are an otherwise healthy adult patient who presents with acute appendicitis, a pediatric patient who presents with a ... Read More

Anesthesia Modifiers Chart

by Niels
Anesthesia Modifiers Chart The chart below lists the ASA ranking of patient physical status and the modifiers and added unit values associated with the rankings.  It also shows three special circumstance modifiers and their added units of value. Patient Physical Status HCPCS Modifier Added Units of Value 1. Normal, healthy patient or patient with mild ... Read More

Modifiers – Anesthesia Related to CRNAs, AAs, Locum Tenens

by Niels
Modifiers – Anesthesia Related to CRNAs, AAs,  Locum Tenens  Medical direction is defined as the medical involvement of an Anesthesiologist or a qualified anesthetist (CRNA), anesthesia assistant (AA), in one, two, three or four concurrent procedures where the Anesthesiologist is physically present. Medicare requires the utilization of CRNAs and AA to be indicated with the ... Read More

Normal, Uncomplicated Anesthesia Modifiers – P1, ZE,ZA

by Niels
All anesthesia claims require a modifier.  Failure to use the applicable modifier will result in the claim being returned to the provider for correction.      Modifier P1 must be billed with the appropriate five-digit CPT-4 anesthesia code to identify a normal, uncomplicated anesthesia provided by a physician.     Modifier ZE must be billed with the ... Read More