Research suggesting nurse anesthetist standalone care is equivalent to physician-led care is flawed, according to a new study published online in Anesthesia & Analgesia.
Here are six insights:
1. According to study results, the frequently used billing code gives a false impression that many nurse anesthetists practice without the supervision of physician anesthesiologists.
2. Nurse anesthetists have two coding options for billing their clinical care for Medicare patients — modifier QX and QZ. The modifier QX is used when the physician anesthesiologist provides a high level of care to the patient.
3. However, modifier QZ is used in several different clinical situations including supervision of the nurse by a physician anesthesiologist, supervision of the nurse by another physician and the nurse working without supervision, as well as a high level of care with limited documentation.
4. For the study, investigators examined 538 hospitals where 100 percent of the anesthesia claims (9,071 in total) used the modifier QZ.
5. However, the study found that physician anesthesiologists were affiliated with 47.5 percent of these hospitals, representing more than 60 percent of the claims.
6. Thus, it is impossible for the modifier QZ to know from billing claims how care was provided.
"Our hypothesis was that if all of the nurse anesthetists' claims represented nurse 'solo' care in these facilities, then there would be no physician anesthesiologists working in these facilities," said Amr Abouleish, MD, MBA, study co-author and professor of anesthesiology at the University of Texas Medical Branch in Galveston. "On the other hand, if there is a physician anesthesiologist at the facility, then he/she is providing care and the modifier QZ cannot be used to represent nurse 'solo' care."