HealthDay News — Many hospitals that exclusively report the modifier QZ, defined by the Centers for Medicare & Medicaid Services to be used for Certified Registered Nurse Anesthetist service: without medical direction by a physician, have affiliated physician anesthesiologists, according to research published recently in A & A Case Reports.

Thomas R. Miller, PhD, MBA, from the American Society of Anesthesiologists in Schaumberg, Illinois, and colleagues examined hospitals that used the modifier QZ exclusively in anesthesia claims. Data were examined for a 5% sample of Medicare beneficiaries in 2013 from 538 hospitals. A national Medicare provider file was used to identify physician anesthesiologists and nurse anesthetists affiliated with these hospitals.

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The researchers found that 47.5% of the hospitals that exclusively reported the modifier QZ had affiliated physician anesthesiologists. Overall, 60.4% of the cases were attributed to these hospitals.

“Our results illustrate the challenges of using modifier QZ to describe anesthesia practice arrangements in hospitals,” the authors write. “The modifier QZ does not seem to be a valid surrogate for no anesthesiologist being involved in the care provided.”


Miller TR, Abouleish A, Halzack NM. Anesthesiologists Are Affiliated with Many Hospitals Only Reporting Anesthesia Claims Using Modifier QZ for Medicare Claims in 2013. A A Case Rep. 2016. doi:10.1213/XAA.0000000000000223.