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The HCPCS anesthesia codes question here was:

“With the Blitz.. I believe Anesthesia video or maybe Modifiers video.. You suggested writing the HCPCS anesthesia codes in the guidelines.. but only 5 of them.. Was wondering what the reasoning for those 5 (AA, QS, QX, QI, QZ). I realized they are all administration codes (who administered anesthesia).. are they the ‘more common' codes or something? I was also informed that they have added Medicare Reimbursement questions to this years CPC and I'm taking my exam March 30th. Do you have any insight into this recent addition?”

Video: HCPCS Anesthesia Codes

She she says that she went through the anesthesia and the modifier videos that Laureen offers and the HCPCS book has some anesthesia modifiers (AA, QS, QX, QI, QZ) and I had suggested or Laureen maybe had suggested; but I used to tell my students to do that. Take those modifiers from the HCPCS book because you don’t use it very much and they’re in alphabetical order, not lumped together under anesthesia. But go in, write those five modifiers into your CPT manual because you’ve got some blank areas and just make a note on them so you’re saving time, not going back and forth. But, she was wanting to know some more information about those.

So, these are HCPCS anesthesia codes or modifiers. AA is saying anesthesia services performed personally by the anesthesiologist. So, when you’re dealing with anesthesia you’ve got anesthesiologist, so he’s an MD or a doctor.

Then you have a CRNA which is a certified registered nurse anesthetist, and so, they are not a doctor but think of them as like a PA (physician assistant) or a nurse practitioner. They are qualified to work procedures and stuff. They are not a nurse; they are a specialty, but not a nurse. They only do anesthesia, nothing else.

QK- this applies to the anesthesiologist again. He is medically directing two, three or four concurrent anesthesia procedures involving qualified individuals – meaning a CRNA. So that means he is there at the facility and there are several procedures going on, CRNAs are doing them but he is there as – he is directing, he is making sure everything is going smoothly.

Now, then you have a QX- that’s for a CRNA service with medical direction by a physician. Now, there are some procedures that it’s required that the CRNA has to have the anesthesiologist in the building, doesn’t necessarily have to be right there with him while he’s doing the procedure but he has to right there on call, in the building. Then, there’re procedures that the CRNA can do on their own. For example, if you’re pregnant and you’re about to deliver, it’s probably going to be a CRNA that’s going to come in and do your episiotomy, if you choose to get one. So, the anesthesiologist doesn’t have to be in the room, but he has to be in the hospital available if the CRNA has a problem. But if it’s something that is just monitoring or something, he doesn’t have to have the direction of the physician, the anesthesiologist doesn’t have to be in the building, QZ – CRNA service without medical direction by a physician.

I think probably maybe wound care clinics or maybe even pain centers probably do with that a little bit. This is an example of a mock exam question. This is from like 2010, 2012, the 11 practice exam. Real quick, I’m not going to really read it because it will be on the Replay Club, but when you see this what they’re wanting you to know is can you distinguish one? If you noticed all of the CPT codes are just about the same except for one. So, you can probably just throw that one out. We are not going to look at that one. I mean, that’s a heads up that nah, that’s probably not a good one. So, we need to confirm the 00220 is right in it, probably not even look at that.

What you need to know is which of those middle modifiers the QK, QX and everything is the proper one to use? Now, the P-modifiers, that has to do with the condition of the patient. So, if the patient is relatively healthy, that’s a P1. If they’ve got some conditions, P2, but anyway, that’s in your manuals and you can look at that a bit also. But, when you’re coding for this, you have to code two separate things. You have to know, is the anesthesiologist there? Is he supervising more than one? You have to code for him, and secondly, you have to code for the CRNA if he is involved.

So, QK, you’ve got QK first on all of those. So, you know QK is dealing with the anesthesiologist, and you have QX. So, look on your test question real quick and you want to ask yourself, who’s doing the procedure? I see CRNA right there on the top so I know he is involved, and what does it say about the anesthesiologist? You just need to pull out what it says, the shunt revision report. Both the anesthesiologist service and the CRNA service… Is there more above that? No, I guess not.

Scroll down and look at the rationales.

Laureen: There’s more.

Alicia: The correct answer is and the reason is “A” because… it goes into detail why the 00220 is the correct CPT code, but it says: “the CRNA under an anesthesiologist medically directing three concurrent cases.” So, that’s in that test question. “The code is reported once for each provider. The anesthesia modifier – QK (medical direction of two to four concurrent cases) indicates that the anesthesiologist was directing… Then, QX was the CRNA with medical direction.

Then, it tells you why the other ones are not the correct answer, but you can catch that on the Replay. For those just to know that when you’re doing those modifiers for an anesthesia – and these will be in your anesthesia section. I think you get about 8 anesthesia questions on the CPC exam, and this is a classic example of that. Now, I remember mine had none of these, but that was some time ago. But I had other people mentioned that yes, there was those modifiers were involved. So, just be aware of them. Take them from your HCPCS manual. Write them in on your CPT so you can do quick reference because like I said, they’re in alphabetical order, so they’re not right next to each other. You want to save every amount of time you can when taking the exam.

More HCPCS Anesthesia Codes Content:

HCPCS Anesthesia Codes VIDEO — CCO Medical Coding

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2017-09-27T14:35:47+00:00

About the Author:

Laureen Jandroep
CPC, COC, CPPM, CPC-I.,Sr. Instructor for CCO.us. Resides in southern New Jersey with her husband of over 20 years Anthony and four children. They are active parents and spend most of their time these days just being parents which they love.

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