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Reporting physical status modifiers on anesthesia claims

Release Date: April 26, 2012

This is a reminder to all providers that provide anesthesia services to follow the policy located in the “Claims and Billing” section of the provider Blue BookSM relating to physical status modifiers for anesthesia services.

Physical status modifiers commonly known as P-modifiers are unique to the reporting of claims for anesthesia services.  These modifiers help to distinguish between levels of complexity in providing anesthesia services comparative to patient health circumstances.  Because of different levels of complexity in providing anesthesia to patients of varying health states, use of a P-modifier can sometimes add an additional base unit (or units) when reported accurately on a claim submission.  Blue Cross and Blue Shield of North Carolina’s (BCBSNC) existing claim submission policy requires a P-modifier (reporting the patient’s condition) to be placed in the first modifier position, following the five-digit procedure code, of any claim submission or electronic transaction reporting anesthesia services. 

BCBSNC has in the past made efforts to correct P-modifier billing errors and manually review and process those claims to recognize P-modifiers reported in secondary positions, as if the modifiers had been reported in the first position of the modifier field.  However, in order to streamline efficiencies and help control administrative costs, as of May 1, 2012, we will begin processing anesthesia claims recognizing P-modifiers based only on the order they’ve been submitted, in accordance with existing policy.  This means that claims appended with P-modifiers located in positions other than the first position of the modifier field will not be eligible to receive P-modifier-associated additional units added to the anesthesia base values.  As of May 1st and afterwards, only claims reported following BCBSNC’s existing billing requirement to place an appropriate anesthesia P-modifier in the first position after the procedure, listed before other modifiers reported on the anesthesia claim, will be processed recognizing additional base value considerations. 

This is a reminder that if you’re a biller of anesthesia services to please follow the requirements stated in the “Claims and Billing” section of the Blue Book and ensure that appropriate patient status modifiers are located in the first modifier position of your anesthesia claim submissions.  Recognized P-modifiers include: 

  • 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 being removed for donor purposes

Please note:  Modifiers are subject to change as nationally recognized code sets change.  Additionally, claims for anesthesia services should continue to be filed with all appropriate modifiers listed, including those for timed anesthesia.