Name of Manual - Blue Cross and Blue Shield of Minnesota

Part-time (Medically
Directed) Anesthesia
Services
Qualifying
Circumstances
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (02/21/12)
Coding Policies and Guidelines (Anesthesia)
Medically directed anesthesia services are provided by the
anesthesiologist when he or she is supervising two or more
CRNAs. The anesthesiologist may perform the induction and
emergence but is not necessarily present during the entire
operative session and may be supervising two or more procedures
at the same time.
• Use modifier -AD or -QK for the medical direction provided
by a physician (part-time services).
• Use modifier -QY for part-time medical direction of one
CRNA by an anesthesiologist.
• Use modifier -QX for medically directed CRNA services (parttime).
• Modifier -QS would be used for part-time monitored
anesthesia care.
The HCPCS level II modifiers (AD, QK, QS, QX and QY)
should be listed in the first modifier position.
In accordance with CPT, the following circumstances are
recognized for submission of risk. These codes are not stand-alone
services. Qualifying circumstance codes billed without an ASA
service on the same claim will be rejected. The corresponding
eligible base units that may be allowed are also listed. Anesthesia
risk factors will be priced independently of the anesthesia line for
easier posting of payments to accounts and greater accuracy of
payments.
Code Base
Units
Description
99100 1 Anesthesia for patient of extreme age; younger
than 1 year and older than 70
(List separately in addition to the code for the
primary anesthesia procedure.)
99116 5 Anesthesia complicated by utilization of total
body hypothermia
(List separately in addition to the code for the
primary anesthesia procedure.)
99135 5 Anesthesia complicated by utilization of
controlled hypotension
(List separately in addition to the code for the
primary anesthesia procedure.)
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