Anesthesia Coding Alert

Question: One of our CRNAs says that if the patient loses consciousness during a MAC (monitored anesthesia care) case, the case is then considered "general anesthesia." Is this true, and how should we code the case? Nebraska Subscriber Answer: Many MAC patients lose consciousness. Consequently, coding for it depends partly on the anesthesia provider's assessment of the situation. Deep sedation is still MAC, but general anesthesia is not; the person administering anesthesia should classify it as "MAC" or "general" because he or she knows what happened during the procedure and how the patient responded.

Some practitioners use simple actions to help determine whether the case has crossed to general anesthesia. For example, the anesthesia provider may try to arouse the patient by a gentle pat on the cheek or by calling his name. If the patient cannot be aroused in this manner, then the practitioner probably considers the sedation to be general anesthesia. In either case, the appropriate codes for the situation are the same for MAC and general anesthesia. The only difference is that you should add the applicable MAC modifier(s) (-QS, Monitored anesthesia care service; -G8, Monitored anesthesia care for deep complex, complicated or markedly invasive surgical procedure; and -G9, Monitored anesthesia care for patient who has history of severe cardiopulmonary condition) when stipulated by your local carrier.