Anesthesia Coding Alert

Question: One of our clients performs left-heart catheterizations and percutaneous transluminal coronary angioplasty (PTCA). Would the anesthesia be considered monitored anesthesia care (MAC) if the physician writes anesthesia stand-by for the type? How should I code for the anesthesia?

Colorado Subscriber

 
Answer: Stand-by anesthesia and MAC are two different things. Stand-by anesthesia means that the availability of anesthesia was assured, but it does not include any direct patient care by the anesthesiologist. MAC is a service provided to the patient, where a patient record is created and the patient receives care and the anesthesiologists presence and time. Almost all carriers will pay for medically necessary MAC, but very few pay for a service that was available but not used (e.g., stand-by anesthesia). Report anesthesia with 01920 (Anesthesia for cardiac catheterization including coronary angiography and ventriculography [not to include Swan-Ganz catheter]). Appending modifier -23 (Unusual anesthesia) and including documentation might help because carriers may feel that anesthesia would be unnecessary for this procedure.