Know Limitations of G8 Modifier
Question: Can I apply modifier G8 for any procedure for a Medicare beneficiary if the documentation says the procedure is complicated and invasive? Arizona Subscriber Answer: No. According to the Centers for Medicare & Medicaid Services (CMS), modifier G8 (Monitored anesthesia care (mac) for deep complex, complicated, or markedly invasive surgical procedure) is only appropriate for certain procedures. Other payers’ policies may vary, but according to local coverage determination (LCD) A57361, “Anesthesia procedures listed in … this article are examples of those that are usually provided by the attending surgeon and are included in the global fee and are not separately billable. In certain instances, however, MAC [monitored anesthesia care] provided by anesthesia personnel may be necessary for these procedures if the patient has one or more of the conditions or situations ….” (See the article for specifics.) In some of these situations, the LCD says modifier G8 should be appended when the respective procedure CPT® code is not fully descriptive, but only for certain anesthesia codes, including: The LCD says that documentation must list special conditions/criteria leading to the use of MAC, and diagnoses also must support the MAC being medically necessary. Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC
