In simple words: An anesthesiologist is overseeing the work of a nurse anesthetist during your procedure.

This modifier is used when an anesthesiologist medically directs one CRNA during a single anesthesia procedure. The anesthesiologist must perform the pre-anesthesia examination and evaluation, prescribe the anesthesia plan, personally participate in the most demanding procedures, monitor the course of anesthesia, remain physically present for emergencies, and provide post-anesthesia care.

Example 1: A patient undergoes a hernia repair surgery. An anesthesiologist medically directs a CRNA who administers the anesthesia. The anesthesiologist uses QY, and the CRNA uses QX., A patient has a knee replacement surgery. A CRNA administers the anesthesia under the medical direction of an anesthesiologist. The anesthesiologist bills with QY, while the CRNA bills with QX., A patient undergoes a carpal tunnel release surgery. An anesthesiologist medically directs one CRNA to administer the anesthesia. The anesthesiologist uses modifier QY.

Documentation should support the medical direction provided by the anesthesiologist, including pre-anesthesia evaluation, anesthesia plan, participation in key portions of the procedure, monitoring, and post-anesthesia care.

** Check payer rules regarding what qualifies as medical direction. Payment is typically at 50% of the personally performed rate to both the anesthesiologist and the CRNA.