Anesthesia Coding Alert

Question: What guideline should I follow when determining whether to code a case using propofol as MAC or general anesthesia? What about situations when the patient is awake intermittently throughout the procedure (such as during a breast biopsy or lesion removal)?


North Carolina Subscriber


Answer: Some coders believe that if the anesthesiologist uses propofol and the patient is unconscious for two-thirds of the case, it becomes general anesthesia. The truth is, the case becomes general anesthesia if the patient loses control of his airway for any length of time.

The American Society of Anesthesiologists substantially revised its MAC policy in 2004 to offer guidance on the differences between MAC and general anesthesia. The updated position states, -If the patient loses consciousness and the ability to respond purposefully, the anesthesia care is a general anesthetic, irrespective of whether airway instrumentation is required.-

Because of this position--and because you don't indicate a loss of airway in your question--you should consider this a MAC case.
 
Report the appropriate anesthesia code for the procedure, but also report any MAC modifiers that might apply (depending on the carrier and the patient situation). These could include QS (Monitored anesthesia care service), G8 (Monitored anesthesia care [MAC] for deep complex, complicated, or markedly invasive surgical procedure) and G9 (Monitored anesthesia care for patient who has history of severe cardiopulmonary condition).