Coding & Billing: Clarify 'present & Immediately Available'

'Physically present and available' can be one of the most difficult factors to determine when confirming medical direction

. You should keep these guides in mind when deciding whether your anesthesiologist's claim still merits medical direction modifiers QY or QK.

Think about individual circumstances

Vague medical direction rules like 'remains physically present and available for immediate diagnosis and treatment of emergencies' allow for individual interpretation.

Defining 'immediately available' accurately is more than looking at the hospital's blueprints to see how far your physician walks down the hall. Interpretation also takes each situation into account. For instance, the anesthesiologist needs to be more easily available to help during an emergency when he is medically directing an aneurysm repair versus a hernia repair.

Think about these three factors when trying to determine what qualifies as 'physically present and available' in your hospital.

OR Size:

Service location:

Patient condition:

Key determinant: Think how quickly the anesthesiologist could help the medically directed CRNA in the event of an emergency. If the anesthesiologist is away from the OR suite or outside the surgery department, is he 'immediately available' to return if required? If so, his work might still fit under the medical direction umbrella; if not, you might need to rethink his status.

Know how the factors impact coding & billing

The factors listed above will not change your code for the procedure itself, however can change the anesthesiologist's performance modifier and his reimbursement. If the anesthesiologist personally carries out a case, you know where he is for the entire procedure and report modifier AA with the procedure code. The carrier shells out money for the entire case.

Coding gets tougher when the anesthesiologist oversees other members of the team rather than personally performs cases. If he medically directs one CRNA, report modifier QY with the procedure code; if he directs from two to four anesthetists, report modifier QK instead. Doctors who medically direct cases split the procedure fee with the other anesthetist involved.

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by: James Article

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