Wiki MAC without sedation

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abullock15

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I have a provider that is asking if they can bill for monitored anesthesia care without sedation for facet joint injections, when medically necessary. The pain clinic that he works for is asking that he be present for all procedures in case it is necessary to provide anesthesia at time of service. The patients do not always end up requiring anesthesia but he is continuously monitoring each patient throughout the procedure. He is performing all requirements of MAC, including a pre and post evaluation, on all patients.

Does anyone have any experience with this situation?

Thanks in advance,
Abbi Wurth
 
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Hi,

I'm a little confused here. If MAC during the procedure is medically necessary for a patient, that would be fine. It's understood that the anesthesiologist might not administer sedatives during MAC.

Here's the ASA on MAC:

Monitored anesthesia care includes all aspects of anesthesia care – a preprocedure assessment and optimization, intraprocedure care and postprocedure management that is inherently provided by a qualified anesthesia provider as part of the bundled specific service. During monitored anesthesia care, the anesthesiologist provides or medically directs a number of specific services, including but not limited to:​
  • Preprocedural assessment and management of patient comorbidity and periprocedural risk
  • Diagnosis and treatment of clinical problems that occur during the procedure
  • Support of vital functions inclusive of hemodynamic stability, airway management and appropriate management of the procedure induced pathologic changes as they affect the patient’s coexisting morbidities
  • Administration of sedatives, analgesics, hypnotics, anesthetic agents or other medications as necessary for patient safety
  • Psychological support and physical comfort
  • Provision of other medical services as needed to complete the procedure safely.
Monitored anesthesia care may include varying levels of sedation, awareness, analgesia and anxiolysis as necessary. The qualified anesthesiologist provider of monitored anesthesia care must be prepared to convert to general anesthesia and respond to the pathophysiology (airway and hemodynamic changes) of procedure and position in the management in induction of general anesthesia when necessary.
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However, I'm not sure what you mean when you say the clinic wants him to be present for all procedures in case he needs to provide anesthesia. Just to be clear - he can only bill MAC if MAC is medically necessary for the specific patient.

I provided an excerpt from Anthem's policy on MAC for interventional pain services in case anyone is curious about typical diagnoses, it's typical of what I've seen in payer policies.

For interventional pain management procedures, including but not limited to nerve blocks, anesthesia services including monitored anesthesia care (MAC) are considered medically necessary when the following criteria have been met:
  1. There is documentation that the individual's condition requires the presence of qualified anesthesia personnel to perform monitored anesthesia in addition to the physician performing the procedure; and
  2. The medical condition or procedure must be significant enough to require the need for anesthesia services, including MAC. Such conditions or procedures may include, but are not limited to the following:
    1. Significant medical conditions (ASA physical status 3 or above) that increase risk for complications including cardiac disease, pulmonary disease, and morbid obesity (body mass index [BMI] greater than or equal to 40 kg/m2); or
    2. Sleep apnea; or
    3. History of complications during sedation; or
    4. Severe anxiety, psychiatric conditions, or cognitive impairments that decrease safety during the procedure; or
    5. Spasticity or neurological conditions that decrease safety during the procedure; or
    6. Procedures requiring individuals to remain motionless for a prolonged period of time; or
    7. Procedures requiring individuals to remain in a painful position; or
    8. Individuals under the age of 18.
  3. Note: Complex procedures and procedures in high-risk individuals may justify the use of an anesthesiologist or anesthetist to provide conscious sedation or deep sedation. See Appendix for physical status classifications. The presence of a stable, treated condition of itself is not necessarily sufficient.
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https://www11.anthem.com/ca/medicalpolicies/guidelines/gl_pw_d087067.htm
 
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jkyles said:
Hi,

I'm a little confused here. If MAC during the procedure is medically necessary for a patient, that would be fine. It's understood that the anesthesiologist might not administer sedatives during MAC.

Here's the ASA on MAC:



However, I'm not sure what you mean when you say the clinic wants him to be present for all procedures in case he needs to provide anesthesia. Just to be clear - he can only bill MAC if MAC is medically necessary for the specific patient.

I provided an excerpt from Anthem's policy on MAC for interventional pain services in case anyone is curious about typical diagnoses, it's typical of what I've seen in payer policies.


https://www11.anthem.com/ca/medicalpolicies/guidelines/gl_pw_d087067.htm
Click to expand...
If they are not administering medication, why would they need to monitor? Can a CRNA bill for just monitoring?
 
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