Update of Monitored Anesthesia Care Billing

TO: ALL UW ANESTHESIOLOGY FACULTY AND RESIDENTS
FROM: Karen Low <low@u.washington.edu>

Noridian, the Medicare carrier for 11 western states, has implemented a new Local Medical Review Policy (LMRP) related to billing and payment for Monitored Anesthesia Care (MAC) provided to Medicare patients.

For 24 anesthesia CPT codes the policy assumes that; if the type of anesthesia is not general or regional, no anesthesia service is required. Therefore, if the type of anesthesia is MAC, special rules will apply for billing and payment

Justification for MAC will be reported by the use of special modifiers and certain diagnosis codes. The medical record must contain documentation supporting level of service billed for.

Whenever MAC is the type of anesthesia, "MON" should be recorded in the "Agents and Techniques" section of the anesthesia record.

Professional staff needs to be aware of three areas where this policy will most commonly apply:

  1. Anesthesia for procedures on the skin and subcutaneous tissues (00300, 00400), procedures on the nose (00160), and for anesthesia for access to the central venous circulation (00532): If the surgical procedure is deep, complex, complicated or markedly invasive, then modifier G8 can be added to provide justification for MAC.

  2. Anesthesia for pacemaker insertion: Recording of the diagnosis code for the underlying reason for the need for a pacemaker is required.

  3. Anesthesia for upper or lower gastrointestinal endoscopic procedures:
    The reason anesthesia services are required needs to be documented in the "comments" section of the anesthesia record.

 

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