Medicare Won't Pay, but Others Might
If Medicare covers the bulk of your patients, you might not think to add qualifying circumstances (QC) codes to claims when it's appropriate because Medicare doesn't reimburse for them. But leaving QC codes off claims you submit to non-Medicare carriers which do reimburse for qualifying circumstances is a mistake you don't want to make.
Many anesthesiologists provide services in particularly difficult circumstances, such as during a liver transplant for a patient with end-stage liver disease. The qualifying circumstances codes reflect some of that added difficulty and help the anesthesia provider receive more appropriate reimbursement for services.
The anesthesia-related QC codes include:
Since these are classified as add-on (or secondary) codes, you report them in addition to the anesthesia code for the procedure. You can also use QC codes with surgical CPT codes (whether you're using surgical codes because the carrier requires them or because the anesthesiologist performed a surgical-type procedure such as a pain relief injection), says Emma LeGrand, CCS, CPC, office manager for New Jersey Anesthesia Associates in Florham Park. Just be sure to submit the claim with 7"" (anesthesia) as the type of service if you're reporting anesthesia care with surgical codes.
In what real-life situations can the QC codes be used? LeGrand; Darlene Isom" billing supervisor in the anesthesia department of Northwestern Medical Faculty Foundation Inc. in Chicago; and Lori Mehlbauer an anesthesia coder in Louisville Ky. offer these examples for when you're dealing with non-Medicare carriers.