Q. How does the AD modifier affect the billing and reimbursement of the practice?
A. The AD modifier is reimbursed differently than medical direction. In the traditional 4:1 medical direction model (modifier QK), the anesthesiologist is reimbursed for fifty percent of the payment for each case and each CRNA (modifier QX) is reimbursed for fifty percent of their case. If the AD modifier is used, the anesthesiologist is not subject to the TEFRA rules, but must be present for each induction—at a minimum. If so, the anesthesiologist is reimbursed for 3 base units + 1 unit of time per case. The CRNA (modifier QX) is reimbursed for fifty percent of each respective case.
The AD modifier is used when:
-The anesthesiologist is involved in conducting more than four procedures concurrently.
-The anesthesiologist is performing other services while medically directing concurrent procedures. There are several exceptions to this requirement:
- Addressing an emergency (of short duration) in the immediate area
- Administering an epidural to ease labor pain
- Periodic (not continuous) monitoring of an obstetrical patient
- Receiving patients entering the operating suite for the next surgery
- Checking or discharging patients in PACU
- Handling scheduling matters
These exceptions do not apply if the anesthesiologist:
a) Leaves the operating suite for anything other than short durations,
b) devotes extensive time to an emergency case, or
d) is otherwise unavailable to respond to the immediate needs of surgical patient.
If you have questions about anesthesia billing or compliance, give us a call. We’d be happy to provide a risk-free consultation.
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