Anesthesia Coding Alert

Payer policies dictate when MAC modifiers apply.

Even if your anesthesia provider marks "MAC" (monitored anesthesia care) on a patient's chart, read through the anesthesia record and check with the physician or CRNA before making coding assumptions.

Here's why: If the patient was unable to respond purposefully and did lose consciousness during the procedure, the case qualifies as general anesthesia -- which means MAC coding doesn't apply. Verify your provider's service to ensure you correctly report the care.

Know the Circumstances That Merit Modifiers

When you do report MAC, check whether the payer requires you to append special modifiers for Medicare patients. HCPCS includes three options:

• G8 -- Monitored anesthesia care (MAC) for deep, complex, complicated, or markedly invasive surgical procedure
• G9 -- Monitored anesthesia care (MAC) for patient who has history of severe cardiopulmonary condition
• QS -- Monitored anesthesia care service.

If your carrier requires MAC modifiers, append modifier QS to the claim unless special circumstances apply. For carriers that require modifiers G8 and G9, append those instead of QS, says Kelly Dennis, MBA, ACS-AN, CAN-PC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fl.

Example: The anesthesiologist personally administers MAC during Mrs. Smith's breast biopsy. You'll submit 00400 (Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified) for the procedure and append either modifier QS or G8. However, if Mrs. Smith had a history of cardiac issues (such as bypass surgery), you would append modifier G9.

Get Familiar With Payer Policies

"Some Medicare policies now specify that G8 is reserved for those cases such as male/female genitalia, certain breast procedures, and cardiac pacemaker procedures," says Leslie Johnson, CCS-P, CPC, manager of coding, compliance, and education for Somnia Anesthesia Services, Inc., in New Rochelle, N.Y. Affected procedure codes include:

• 00920 -- Anesthesia for procedures on male genitalia (including open urethral procedures); not otherwise specified
• 00940 -- Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); not otherwise specified
• 00400 -- Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified
• 00300 -- Anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck, and posterior trunk, not otherwise specified
• 00530 -- Anesthesia for permanent transvenous pacemaker insertion.

Verify whether these same guidelines for G8 usage apply to your Medicare carrier.

"Some of the Medicare contractors will define which anesthesia codes will require the G8 modifier in their local policy," Dennis says. For example, in its explanation of modifier G8, a Trailblazer Health LCD (local coverage determination) states, "This modifier is to be applied to the following anesthesia codes only: 00100, 00300, 00400, 00160, 00532 and 00920."

Cardiac tip: Specify the history of the patient's cardiac diagnosis to help bypass any coding edits that make a payer deny the claim. "Only use G9 when you have some kind of documentation via a secondary or tertiary diagnosis to support its use," Johnson says. "Otherwise you'll have to wait for the denial and provide the information then."

Don't Expect Extra Pay

MAC modifiers give more information about the procedure and circumstances, but they don't affect your bottom line. Report the MAC modifier in the second or third position, after the anesthesia performance modifier that factors into payment, such as AA (Anesthesia services personally performed by an anesthesiologist).

Editor's note: For more on understanding the differences between MAC and moderate sedation, see "Learn Definitions and Focus on Airway to Separate MAC from Moderate Sedation" in Anesthesia Coding Alert, Vol. 14, Number 7.