Wiki MAC Vs Moderate Sedation Vs Conscious sedation

[vidraj]

Hello experts,

Hope one of you can help me with my confusion.




My surgeon sent the above OP note, performed at an ASC facility, which states Monitored anesthesia care( MAC) but told us that she provided the conscious sedation.

Monitored anesthesia care includes Moderate or Conscious sedation, is that right?
So, can I bill this as 99152 and 99153 based on the 30 mins monitoring time, as a profee coder?
Or is there any other specific documentation changes which need to be done before we bill it?

 

[jkyles]

Hi there.
No, MAC doesn't include moderate sedation. If you look at the CPT manual's guidelines for moderate sedation you'll see that you can't report MAC with moderate sedation codes. The guidelines will also tell you whether the documentation supports a moderate sedation service. Based on what you've provided it does not.

 

[Icode4U]

MAC anesthesia — also called monitored anesthesia care or MAC, is a type of anesthesia service during which a patient is typically still aware, but very relaxed.


The amount of sedation provided during MAC is determined by the anesthesia professional (physician anesthesiologist or nurse anesthetist) providing the care.

A patient may be only lightly sedated, moderately sedated, or deeply sedated to the point that they’re completely unaware of the procedure. The patient may not even remember any events during the procedure.

The level of sedation administered depends on the health of the patient and the type of surgical or diagnostic procedure being done. This type of anesthesia is typically used for outpatient procedures where the patient will be going home once the anesthesia wears off.

 

[vidraj]

MAC anesthesia — also called monitored anesthesia care or MAC, is a type of anesthesia service during which a patient is typically still aware, but very relaxed.

Hi there.
No, MAC doesn't include moderate sedation. If you look at the CPT manual's guidelines for moderate sedation you'll see that you can't report MAC with moderate sedation codes. The guidelines will also tell you whether the documentation supports a moderate sedation service. Based on what you've provided it does not.

Thank you both for your responses. I just reviewed the guidelines, and it does state that MAC doesn't include moderate sedation.

So, my final takeaway :

• Our surgeon has to mention the conscious sedation instead of MAC
• With a supportive documentation - " Conscious sedation administered under my supervision and patient was monitored throughout the procedure with blood pressure, telemetry and oxygen saturation for xxxx minutes.

Will the above suffice for me to bill 99152 and 99153?

 

[jkyles]

Thank you both for your responses. I just reviewed the guidelines, and it does state that MAC doesn't include moderate sedation.

So, my final takeaway :

• Our surgeon has to mention the conscious sedation instead of MAC
• With a supportive documentation - " Conscious sedation administered under my supervision and patient was monitored throughout the procedure with blood pressure, telemetry and oxygen saturation for xxxx minutes.

Will the above suffice for me to bill 99152 and 99153?

Hi there, no that isn't complete. For example, who is the person the physician supervised, what drugs were administered? For documenting time it needs to be completely clear that you're just talking about the intraservice time as defined in the manual. Then you can look at the time chart in the manual to see how many units you'll report.

 

[vidraj]

Thank you, Kyles, for getting back on this.

Let me review the anesthesia sheet notes and check if all details are available a.
" intraservice time" - Attached AAPC document for future references.
Learning quite a bit on sedation documentation here! Appreciate your guidance.

Vid