Physical status modifiers (PS)

(Priority Health accepts these modifiers, but they do not affect payment)

• P1: A normal healthy patient
• P2: A patient with mild systemic disease
• P3: A patient with severe systemic disease
• P4:A patient with severe systemic disease that is a constant threat to life
• P5: A moribund patient who is not expected to survive without the operation
• P6: A declared brain-dead patient whose organs are removed for donor purposes

Modifiers

• 22: Unusual Procedure/Service: use the Explanation form
• 23: Unusual Anesthesia (Usually done under local but requires general)
• 32: Mandated Services (Related to mandated consult or service)
• 47: Anesthesia by Surgeon (Attached to the appropriate surgery code)
• 51: Multiple Procedures
• 53: Discontinued Procedures
• 59: Distinct Procedural Service
• 78: Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional following Initial Procedure for a Related Procedure During the Postoperative Period

HCPCS Level II modifiers

When related anesthesia services are billed by a CRNA and an anesthesiologist (for medical direction/oversight), the fee is split and each are reimbursed at 50%.

• QB: Physician provided service in a rural HPSA
• QK: Medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals
• QS: Monitored anesthesia care service (MAC)
• QX: CRNA service: with medical direction by a physician
• QY: Medical direction of one CRNA by an anesthesiologist
• QZ: CRNA service: without medical direction by a physician (CRNA paid at 100%)

Residents performing anesthesia services

• Services should be reported under a supervising anesthesiologist
• GC modifier should be coded to indicate services were performed in by part by a resident under the direction of a teaching physician
• AA modifier should be coded to indicate anesthesia services were performed personally by anesthesiologist

If medical direction is provided to more than one case, the appropriate modifier for multiple case oversight should be utilized.

Priority Health follows CMS's teaching physician guidelines. These should be clearly documented and detailed in the medical record. Review the requirements.