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MAC for Colonscopies

  1. #1
    Location
    Greeley, Colorado
    Posts
    2,045
    Question MAC for Colonscopies
    Medical Coding Books
    Does anyone do this?
    Lisa Bledsoe, CPC, CPMA

  2. #2
    Default
    i code for colon/medicare all the time,what is the question?

  3. #3
    Default mac
    Most of ours are not MAC, I think the majority here are conscious sedation, and the few we do get with anesthesia do not use MAC, they just do general. Sorry, I can't help you much.

  4. #4
    Default
    I use MAC all of the time for our CRNAs. whats your question?
    Julie S., CPC
    Anesthesia Coder
    Education Officer, Cleveland Area Chapter 2016
    Email: medcoder05@gmail.com

  5. #5
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Specifically, does anyone do colonoscopies under MAC? If so, is it reimbursed?
    Lisa Bledsoe, CPC, CPMA

  6. #6
    Default
    Yes, we do and yes, they are covered. We currently have NO issues with reimbursement from any carrier - I'm sure I'll be struck by lightening for saying that. In the past we've had payment issues from Medicare, however, our current carrier (WPS) has no monitored anesthesia care policy.

    Julie, CPC

  7. #7
    Location
    Greeley, Colorado
    Posts
    2,045
    Question medical necessity
    Julie - do you have an ABN or waiver signed for medical necessity?
    Lisa Bledsoe, CPC, CPMA

  8. #8
    Default
    No ABN or waivers are not routinely done. There are occasions when we do get a Medicare ABN signed as a result of our previous Medicare carrier having a rigid MAC LCD and the anesthesia providers just following previous guidelines. I have spoken to my administrator about this as it is only appropriate to have the beneficiary sign an ABN when the provider knows the service is noncovered which, per my previous post, there is no current local coverage determination with our current Medicare carrier -- but I won't go into this situation. We have never had Medicaid or Commercial insured patient's sign waivers. Of recent, I can only think of one colonscopy that has been denied and it was a Medicaid denial of screening colonoscopy (GI surgeon was also denied payment) and pt had no symptoms which is not covered by Nebraska Medicaid.

    Julie, CPC

  9. #9
    Location
    Greeley, Colorado
    Posts
    2,045
    Wink
    Julie - I appreciate your input. I find it interesting that some places outside of the US are doing colonoscopies without even conscious sedation, yet we in the US are even going so far as to use MAC or general anesthesia. I do not do anesthesia coding but I work for a multi-specialty group and we also have an ASC. The Anesthesia group that provides services in our facility approached our GI docs with this idea. One wants to do it, one does not. I'm just trying to gather my facts for them and our ASC manager. Thanks again.

    If anyone else has anything to add I'd love to hear from you!
    Lisa Bledsoe, CPC, CPMA

  10. #10
    Default
    Lisa,

    The colonoscopies and EGDs that we provide anesthesia for are in a hospital inpatient and outpatient setting. For the most part our GI patient's are Medicare beneficiaries with co-mobidities (i.e. renal failure, heart failure, DM) or mentally challenged. We do not currently provide anesthesia for these services at any ASC or GI specific facility but there is a free standing GI facility in town that does offer in office endoscopy services. Because we are not affiliated with the facility I'm not certain if it is an ASC or not. These are the same surgeons that bring the Medicare patients to my hospital for endoscopy under anesthesia.

    I see by your profile that you are from Colorado. I'm also finding that your Medicare Part B contractor is TrailBlazers. This carrier DOES have a Monitored Anesthesia Care (MAC) LCD. Per this LCD both of the endoscopy anesthesia codes 00740 and 00810 are among the list of codes that require medical necessity by way of either a specific diagnosis from the covered diagnosis list OR -G9 modifier. I have attached the Trailblazer link to the policy.

    http://www.trailblazerhealth.com/Too...831&DomainID=1

    Feel free to send me a private message with your phone number if you want to discuss any of this in detail.

    Julie, CPC
    Last edited by jdrueppel; 04-23-2009 at 11:04 PM.

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