Revenue Cycle Insider

Question: A urologist performs hydrodistention under monitored anesthesia care (MAC). Is MAC considered the same as local anesthesia? Should I assign 52265 for the procedure?

Ohio Subscriber

Answer: Local anesthesia is an anesthetic applied to a specific area of the body to numb the structures for a procedure. The patient is still awake for the procedure but shouldn’t feel pain during the surgery. For example, the physician injects the patient with a numbing agent prior to stitching a cut.

General anesthesia is used for major procedures, and the patient is unconscious during the operation. MAC, which is also known as sedation, “typically is used for minor surgeries or for shorter, less complex procedures, when an injection of local anesthetic isn’t sufficient but deeper general anesthesia isn’t necessary,” according to the American Society of Anesthesiologists.

The Centers for Medicare & Medicaid Services (CMS) states in Chapter 12 of the Medicare Claims Processing Manual that a physician or qualified individual under the direction of a physician should monitor the “patient’s vital physiological signs in anticipation of the need for administration of general anesthesia or of the development of adverse physiological patient reaction to the surgical procedure.”

You’ll assign 52260 (Cystourethroscopy, with dilation of bladder for interstitial cystitis; general or conduction (spinal) anesthesia) to report the hydrodistention procedure under MAC. Code 52265 (… local anesthesia) is the incorrect code since it includes local anesthesia, which is different from MAC.

Mike Shaughnessy, BA, CPC, Development Editor, AAPC