Ever wondered how to report anesthesia services when there is a physician anesthesiologist, anesthesia assistant (AA), or certified registered nurse anesthetist (CRNA) involved? Details and specificity are key to getting your claims processed, and anesthesia billing is no different. There are some specific anesthesia modifiers that you can append to indicate to the payer the exact role a CRNA, AA, or physician anesthesiologist played during the procedure.
However, this guide will cover only one of those modifiers, i.e., the modifier QZ. We will try to cover all aspects related to this modifier’s accurate usage to help you streamline your anesthesia billing workflow with error-free coding. Thus, if you are a CRNA or a medical practice that provides anesthesia services, we advise you to read this guide till the end!
QZ Modifier – Description
The modifier QZ is a medical direction modifier besides being a pricing modifier. For the unversed, a medical direction modifier is used in anesthesia billing to indicate to the insurance payer that an anesthesiologist was involved in the care procedure without performing any other service. Contrarily, a pricing modifier impacts the reimbursement rate.
There are several medical direction modifiers, including QK, QX, QD, etc. However, we will talk about the QZ modifier specifically. It is a two-character HCPCS modifier that is added to the claim to identify that a CRNA provided services without the medical direction of a physician anesthesiologist.
Now, let’s discuss a CRNA more! A CRNA is a registered nurse who may directly submit claims to Medicare for the services performed or make payment to an entity or employer, such as an ambulatory surgical center, physician, or hospital with which they have a contract.
These registered nurses:
- Graduated from a nurse anesthesia educational program that complies with the standards set forth by the Council on Accreditation of Nurse Anesthesia Programs.
- After graduation, passed the examination for the certification of the Council on Recertification of Nurse Anesthetists or the Council on Certification of Nurse Anesthetists within 24 months.
- Satisfied the licensure requirements of the state that they practice concerning non-physician anesthetists.
Scenarios Where a QZ Modifier is Applicable
Discussed below are some real-world scenarios where modifier QZ is applicable:
Remote Anesthesia Care Unit (RACU)
Imagine a dedicated RACU in a hospital setting, where a CRNA provides anesthesia services independently during procedures to patients in remote locations, such as the interventional radiology department or the endoscopy suite. The QZ modifier will be applicable in this situation since the CRNA renders the services without a physician anesthesiologist.
Anesthesia Services in Rural Hospital
Let’s assume a scenario in which a CRNA renders anesthesia services for a knee arthroscopy procedure in a rural hospital. However, the hospital has limited physician anesthesiologists, and due to its location, calling in external physicians is a challenge. Thus, the CRNA administers anesthesia without supervision. As a result, the claim must include modifier QZ to ensure rightful reimbursements for the CRNA.
Outpatient Surgery Center
Consider an outpatient surgery center that specializes in minor surgeries, such as dental extractions and endoscopies. Due to the limited scope, the healthcare facility employs CRNAs who administer anesthesia without medical direction from physician anesthesiologists. As a result, the QZ modifier will apply to the procedures for payments against the CRNA services.
Modifier QZ – Billing Guidelines
Scenarios can only give you a glimpse into how the application of modifier QZ works. But, in reality, there are more factors that must be considered to ensure appropriate usage of this modifier. Thus, this section will cover all the billing guidelines to ensure you receive timely and rightful payment against your rendered anesthesia services as a CRNA. So, without further ado, let’s get started!
- You can append this modifier to only anesthesia procedure codes (00100-01999).
- Since it is also a pricing modifier, it must be placed in the first position, and all other relevant modifiers (if any) will come after it.
- Do not use the modifier QZ if a physician provides medical direction to the CRNA for administering anesthesia to the patient, since in that scenario, modifier QX is applicable.
- You will receive 100% payment by appending this modifier since it indicates to the payer that the CRNA performed anesthesia services without supervision.
- You must include comprehensive documentation of how the CRNA administrated the anesthesia and explicitly state that no medical direction was involved. If there is a specific reason behind the absence of a physician anesthesiologist, record that as well.
- Avoid using this modifier unnecessarily to get unfair higher reimbursements, as it may result in claim denial, audits, and reputational damage, such as legal actions and hefty financial penalties.
- Review and ensure compliance with all relevant state laws and regulations regarding independent anesthesia care and CRNA scope of practice.
- Note that the specific billing requirements and reimbursement guidelines may vary across various payers. Thus, we recommend you check with the relevant insurance company before appending modifier QZ to avoid payment delays and denials.
Summary
Let’s wrap up by quickly revisiting all the key points that we discussed in this guide! We explained that the QZ modifier is a pricing and medical direction modifier that is appended to indicate that a CRNA administered anesthesia services without the supervision of a physician anesthesiologist.
Moving forward, we also shared some practical scenarios where this anesthesia modifier may apply, including rural hospitals, remote anesthesia care units, and outpatient surgery centers where only CRNAs are in attendance. Moreover, we discussed billing guidelines for accurate usage of this modifier. If you find anesthesia billing requirements overwhelming, you can outsource medical billing services to our specialists at MediBillMD.
