Anesthesia Coding Alert

Question: The patient could not tolerate the procedure under MAC (monitored anesthesia care), so it became a general anesthesia case. Is there a diagnosis code we should report when MAC becomes general?


Rhode Island Subscriber
Answer: The fact that the case began as MAC is immaterial because it didn't stay a MAC case. If the patient loses consciousness, you report the case as general anesthesia. Medicare does have requirements for proving medical necessity for MAC during some anesthesia cases. Because Medicare's standards and need for information are so great, some coders encourage physicians to document every case using Medicare rules, regulations and requirements. Following this advice means you should usually have all the information you need to correctly bill the case.

Once the physician administers a general anesthetic, he is no longer bound by a carrier's MAC guidelines. However, some carriers require justification of any anesthetic given during particular procedures (such as a colonoscopy). Watch for these types of criteria to ensure you meet the carrier's guidelines.