subject: The Most of Incomplete Medical Direction [print this page] When an anesthesia case concerning incomplete medical direction comes to you, some of you might think about creating a claim in the CRNA's name and appended modifier QZ. Here are three things you should keep in mind before taking that road:
Get started with your local carrier
CMS doesn't have a national-level policy for incomplete medical direction. Instead, CMS has directed the local carriers to address this issue case by case. The final determination can vary, depending on the circumstances.
However, in general, the CNRA could submit the claim by using modifier QZ or the physician might report the procedure using modifier AD.
Word of caution: If the anesthesiologist reports modifier AD, the CRNA should report modifier QX instead of QZ. If you submit modifier QZ, the carrier will incorrectly pay 100 percent of the CRNA's services in addition to the physician reimbursement leading to an inadvertent over payment for services.
Play smart: Be certain about who employs the CRNA in order to ensure that the proper entity files the claim. If the group employs the CRNA, it may file the CRNA services with its services. If the group does not make use of the CRNA, the payer normally pays the first claim filed and rejects the second one.
Tread safely: Check with your payers in order to ensure that they can make out all of the HCPCS modifiers you plan to include in your claim. Your reporting method may depend on the exact circumstances that rendered medical direction incomplete.
Stay away from unnecesary hassles by explaining circumstances
When you submit a claim that clearly indicates the portion of the case that met medical direction as well as the portion that didn't, it allows the payer to take a decision based on the circumstances for your specific claim. In some instances, carriers will still permit reimbursement for the entire claim based on medical direction. Irrespective of the appropriate reporting method for your case, always remember that you must think about the physician's time involved when reporting concurrent cases.
By submitting a claim for the CRNA with modifier QZ, you might have eliminated the physician from the claims process. However you still have to account for his or her time involvement when calculating concurrency and determining the right modifiers for any concurrent case.
Keep your medical direction compliant
You ought to be familiar with the seven steps of medical direction and the exceptions that Medicare allows. The anesthesiologist can carry out certain services without interrupting medical direction.
Local watch: The medical direction 'exceptions' vary by state, which can make your coding tricky. So if you want to know more about the ins and outs of medical direction, just avail the services of a one-stop medical coding guide like Supercoder!
