V58.83 Medical Necessity for MAC

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Does anyone know if V58.83 is still an acceptable medical necessity code for MAC when propofol is utilized for the procedure (i.e. endoscopies) specifically for Virigina (Palmetto GBA)? I have searched LCD's and NCD's and have not found this on any current documents.
 

danachock

Guru
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Medical Necessity for MAC

Hi,
I am going to reach out and just share a little information. I know I am not from Virginia but here in MN some of our endoscopic procedures have policies in place by BCBS. With that being said I need to provide documentation on why providing a MAC met medical necessity. I understand the V58.83 - medication monitoring/management. However I don't think that is the code they are looking for??? What type of medication is the patient taking that needs to be monitored? The one that meets medical necessity for me is V58.69which is for the patient taking narcotics for pain, or a different high risk medication (the list could be endless).
I am hoping this may offer some help.
Have a great evening,
Dana Chock, CPC, CCA, CANPC, CHONC, CPMA, CPB
Anesthesia, Pathology, and Laboratory coder
 
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Thanks Dana...I agree with you which is why I am looking for additional information. Apparently in the past (hate that phrase...I am not one of those that does something because that is the way it was always done), if propofol was utilized, Medicare would accept V58.83 as a medical necessity code for the use of an anesthesia provider (vs the surgeon sedating the patient) as anesthesia providers were the only providers who could administer propofol. However, I do not see this anywhere in the current regs and am not willing to utilize it unless I can find it there. Anyone in Virginia aware of this?
 

mitchellde

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V58.83 is therapeutic drug monitoring, such as when you a PT/INR for a payient on coumadin. I cannot see how this code fits into anesthesia for an endoscopic procedure.
 

Billing500

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Has anyone come across an updated LCD# 32628 which lists the applicable ICD10 codes for Medical Necessity as it relates to Monitored Anesthesia Care? CMS published 32628 which lists each "acceptable" ICD9 code, but failed to update this LCD to include ICD10.
 
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