Anesthesia Coding Alert

Question: Our anesthesia team often goes to the cath lab to test an AICD (automatic internal cardioverter-defibrillator) under monitored anesthesia care (MAC). Which code is the best to report?

New York Subscriber  
Answer: Some carriers accept anesthesia code 00520 (anesthesia for closed chest procedures; [including bronchoscopy] not otherwise specified); others accept 00534 ( anesthesia for transvenous insertion or replacement of pacing cardioverter-defibrillator). Code 00534 has a base unit of seven, compared to a base unit of six for 00520. Some coding professionals believe these base units may be a little high for the work involved, and recommend 00400 (anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified) as a better alternative. Regardless of anesthesia code, append modifier -QS (monitored anesthesia care service) to designate MAC service. Depending on the patient's status, modifier -G9 (monitored anesthesia care for patient who has history of severe cardio-pulmonary condition) may also be appropriate if the patient has coexisting medical problems.