Anesthesia Coding Alert

Coding routine versus deep sedation for gastrointestinal (GI) procedures is challenging because carriers descriptions of the physical conditions and diagnoses associated with the procedure vary as do their coding and documentation requirements. Monitored anesthesia care (MAC), used in procedures that do not normally require anesthesia, includes the patients preanesthetic exam, evaluation and postoperative care.

Medicare defines MAC as intraoperative monitoring of patients vital signs in anticipation of a need for general anesthesia or the development of adverse physiological reaction to the surgical procedure. Coders should bill the applicable anesthesia code with modifier -QS (monitored anesthesia care service) attached, according to Medicare Carriers Manual 52018.

You would code a procedure MAC if it required deep sedation and monitoring for vital signs or complications, says Theresa Ruiz-Law, director of managed care and reimbursement for the American Association of Nurse Anesthetists. But dont use MAC for routine situations, such as conscious sedation for colonoscopies or upper GI endoscopies because Medicare will deny it. Carriers in many states, such as New York, assume sedation for endoscopies is standard anesthesia and is included in the fee for the endoscopy procedure.

Be Aware of Carrier Policies for MAC Coding

To provide more detail in addition to modifier -QS, you can append two other HCPCS modifiers, depending on the patients situation and local carrier requirements. Modifier -G8 designates monitored anesthesia care (MAC) for deep complex, complicated, or markedly invasive surgical procedure, while modifier -G9 indicates monitored anesthesia care for patient who has history of severe cardio-pulmonary condition. For example, you would code anesthesia for a lower endoscopy performed with MAC as 00810-QS (anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; MAC service). You would, however, include modifier -G9 if the patients history necessitated it and if the local carrier requires it.

When HCFA introduced the -QS modifier, it said that physician reimbursement for procedures using MAC would not be affected; reimbursement would remain the same. Medicares only reason for establishing this modifier is to track MAC cases so they can formulate a reimbursement policy, says Mark DiDonato, manager of practice activities for the department of anesthesiology at Thomas Jefferson University Hospital in Philadelphia. Medicare might be making plans, but a number of states have already established these types of policies, and DiDonato believes that others are moving in that direction.

File Separate Claims for Reimbursement

Patient conditions and the facility where the procedure was performed also influence a carriers decision to accept separate claims for MAC. Medicare defines a number of conditions that might merit MAC during endoscopic procedures, according to Ruiz-Law. Acute [...]