The Office of Inspector General , U.S. Department of Health & Human Services (OIG) has released its 2015 Workplan. Each year the OIG releases this report which provides notice of the issues it intends to review in the upcoming year. Payment for personally performed anesthesia services remains on the OIG’s Workplan. ASA will again reach out to the OIG to offer assistance with understanding anesthesia coding issues
Anesthesia services—Payments for personally performed servicesWe will review Medicare Part B claims for personally performed anesthesia services to determinewhether they were supported in accordance with Medicare requirements. We will also determinewhether Medicare payments for anesthesia services reported on a claim with the “AA” service codemodifier met Medicare requirements. Physicians report the appropriate anesthesia modifier code todenote whether the service was personally performed or medically directed. (CMS, Medicare ClaimsProcessing Manual, Pub. No. 100-04, ch. 12, § 50) Reporting an incorrect service code modifier onthe claim as if services were personally performed by an anesthesiologist when they were not willresult in Medicare's paying a higher amount. The service code “AA” modifier is used for anesthesiaservices personally performed by an anesthesiologist, whereas the QK modifier limits payment to 50percent of the Medicare-allowed amount for personally performed services claimed with theAA modifier. Payments to any service provider are precluded unless the provider has furnished theinformation necessary to determine the amounts due.